Pet Profile Enrollment Form

General Information:

How did you hear about us? * Owner's Name: * Pet's Name: * Owner's Address: * Home Phone: Email Address: * Daytime or Work Phone: * Emergency Contact Name: * Emergency Contact Phone: * Breed * Color * Sex * Age * Birthday * Is your dog spayed/neutered? Yes     No * Where did you get your dog? * What age was your dog when you got him/her?

Veterinary Information:

* Name of Veterinary Hospital: * Name of Vet most familiar with your dog: * Veterinary Hospital Address: * Veterinary Hospital Phone:

Health Information:

Does your dog have any problems with ticks or fleas? Flea or tick preventative product used: Does your dog have arthritis, joint problems or hip dysplasia? Yes     No If you answered yes, please explain: Are there any restrictions on your dog's movements or activities? Is there a history of medical problems (i.e., seizures) that we should be alert to? Yes     No If you answered yes please explain: List any medications your dog takes:

Behavior:

How does your dog react to strangers? How does your dog react to other dogs? Please describe any problems that your dog has had with any of the following: Barking: Jumping: Mouthing (grabbing but not biting): Housetraining: Leash training or leash pulling: Does your dog growl, snap at or bite someone for approaching their toys or food: Yes     No If yes, please describe the circumstances: Has your dog ever been attacked or bitten by another dog? Yes     No If so, please describe the circumstances: How does your dog react to being crated? Has your dog had any formal obedience/good-manners training? Yes     No If so, where and when: What commands does your dog know?

Client Agreement

Dogs may, without warning, bite or cause injury to humans and other dogs. I acknowledge and understand that there are certain risks involved in participating in daycare, including but not limited to dog fights, dog bites to humans or other dogs, and the transmission of disease. I acknowledge that every dog reacts differently and that animals, by nature, are unpredictable. Please read and initial each statement below: * I understand that by admitting my dog(s) to DHDDC, I am granting permission for my dog(s) to co-mingle and socialize with other dogs. * I understand that dogs unfamiliar with DHDDC may, at first, experience separation anxiety. * I understand that higher levels of activity than dogs are used to, may result in sore muscles, sore joints or fatigue and that high levels of outdoor or high energy play may result in sore paws, blisters, bruises or abrasions on the feet. * I understand that in admitting my dog(s) into DHDDC, DHDDC has relied on my representation that my dog(s) has/have not harmed or shown aggressive or threatening behavior toward any person or other dog. * I certify that my dog(s) is/are in good health and has/have not been ill with any communicable disease within the last 30 days. * I agree to pay for all service due at the time rendered. I understand any unpaid fees by me will be sent to collections and I will be responsible for all collections and legal fees incurred by such actions taken. * I understand DHDDC staff give all pets involved in any type of incident a cursory examination; however, DHDDC is not liable for the location, treatment, or diagnosis of any injuries incurred on DHDDC premises. * I have read and understand the DHDDC "Rules and Regulations." * I grant DHDDC and/or its selected agents full power of decision concerning the care and well being of my dog(s). I understand that DHDDC will make every effort to contact me; however, should any medical emergency arise and I am unreachable, it is agreed that DHDDC or its selected agents can and will make any needed decision concerning medical treatment and choice of caregiver up to $. My signature below authorized the use of my credit card of said purpose. * I hereby hold harmless DOGHOUSE DOGGIE DAY CARE, their successors and assigns, from and against any all claims, causes of action, demands, losses, costs, damages, and expenses (including without limitations, expenses of litigation, court costs, and attorney's fees) in any way arising from or connected with liabilities arising in any manner therefrom.

Final Details:

Please detail any other information about your pet that you feel would be helpful or important to The Dog House staff: The Facility agrees to exercise due diligence and reasonable care, and to keep the premises sanitary and properly enclosed. All pets are handled or cared for by Facility staff without liability on Facility's part for loss or damage from disease, theft, fire, death, escape, injury or harm to persons, other pet(s) or property by said pet, or from other unavoidable causes, due diligence and care having been exercised. Should any pet become ill or seem to be in need of medical consideration, within the sole discretion of the facility staff, the Facility reserves the right to administer aid and/or to use the veterinarian specified by the Owner, or any other veterinarian if necessary. The owner will be notified if possible. Any expenses so incurred shall be paid by the Owner of said pet in addition to other fees incurred for services provided at or by the Facility. Owner agrees to pay the rate for services in effect on the date their pet is checked into the Facility. Prices are subject to change at any time, without notice. Cancellation fees may be applied for reservations cancelled less than 24 hours prior to a scheduled reservation. The Owner shall remain liable for all charges incurred for the care and maintenance of the pet listed on this contract. It is expressly agreed that the Facility's liability shall in no event exceed the sum of $200.00 per animal. The Owner further agrees to be solely responsible for any and all acts or behavior of said pet while in the care of the Facility. The Owner of the pet agrees to pay reasonable attorney fees incurred by the Facility in the collections of any charges for services incurred by the Owner of the pet. Pets must be in good general health and remain current on Rabies, DHLPP, and Bordatella vaccinations, according to their veterinarian's recommendation, when dropped off for any service provided at or by the Facility. The Owner must provide valid proof of all required vaccinations prior to the pet's first visit, when vaccinations are updated, and/or annually. Pets must also be on a prevention program for fleas and ticks, or when specifically requested by the Facility. Pets arriving with fleas and/or ticks may be turned away at the Owner's expense. The Facility expressly disclaims any responsibility for fleas or other parasites. The Facility reserves the right to refuse services or admittance to any dog for any reason. Owner agrees that Owner or a pre-approved Owner's agent will pick up daycare pets by 7:00pm. Charges may be incurred, at prevailing rate, for late pick up. The Facility does provide overnight accommodations arranged in advance by Owner or a pre-approved Owner's agent. Should Owner or pre-approved Owner's agent fail to contact the Facility within 24 hours of the prearranged pick up, the pet will be considered abandoned. Any expenses incurred for the transport, overnight care, and/or placement or adoption of said pet shall be paid by the Owner in addition to other fees incurred for services provided by, at or through the Facility. Owner agrees that their pet may be videotaped, photographed, and/or recorded. The Facility shall be the exclusive owner to the results and all proceeds of such tapings, photography, and recordings with the rights throughout the world, an unlimited number of times in perpetuity, to copyright, to use and to license to others in any manner. Owner further agrees that their pet may be used in any and all media and in the promotion, advertising, sale, publicizing, and exploitation of the Facility. * I understand and agree to the above conditions. * I certify that I have answered the above questions fully and to the best of my ability. * (Owner's Signature) Type your full legal name. * Secure Capture: Type the characters you see in the picture below.