Daycare Application (Emergency Care Permission Form needs to be completed with application)


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NameDaycare Application (Emergency Care Permission Form needs to be completed with application)
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Paws ‘N’ Play Doggy Daycare

562 Reed Road

North Dartmouth, MA 02747

(P) 508-965-7925 / (F) 774-202-2706

Home Away From Home Daycare, Boarding, Training& Grooming




Daycare Application (Emergency Care Permission Form needs to be completed with application)

NAME: ______________________________________________________________ DATE: __________________

ADDRESS: ___________________________________CITY___________________ STATE:________ ZIP:_________

HOME PHONE: ___________________________ DAY PHONE: ____________________ CELL: _________________

EMAIL: _______________________________________________________________________________________ EMERGENCY CONTACT: ____________________________________ PHONE: _____________ ________________

VETERINARIAN NAME: _____________________________________ PHONE: ______________________________
DOGS INFORMATION

DOG’S NAME: _____________________________ BREED: ____________________________ AGE:__________

SEX: M F WEIGHT: _________ AGE WHEN SPRAYED / NEUTERED: ________________________

AGE WHEN ACQUIRED: _____________ WHERE DID YOU OBTAIN YOUR DOG: _____________________________
IS YOUR DOG (PLEASE CHECK ALL THAT APPLY)

ALLOWED TO RUN FREE IN THE HOME:___________________________ SUPERVISED / UNSUPERVISED

ALLOWED TO RUN FREE IN A FENCED IN YARD: ____________________ SUPERVISED / UNSUPERVISED

HAS JUMPED OVER A FENCE IN THE YARD: ________________________ HOW HIGH? ______________

LEASHED WALKS ONLY

OUTSIDE AND UNLEASHED BUT SUPERVISED
DESCRIBE YOUR DOGS TEMPERMENT (PLEASE CHECK ALL THAT APPLY)

LAID BACK SHY OTHER: __________________________________

PLAYFUL AGGRESSIVE

EXCITABLE DOMINANT

HAS YOUR DOG EVER BEEN ON ANY AGILITY EQUIPTMENT? ____________________________________________

DOES YOUR DOG PREFER TO PLAY WITH FEMALE, MALE DOGS OR BOTH? _________________________________

IS YOUR DOG POSSESSIVE OF ANY TOYS, FOOD, OR OBJECTS? IF YES, PLEASE EXPLAIN: _______________________

_____________________________________________________________________________________________

HAS YOUR DOG EVER SHARED HIS/HER FOOD WITH OTHER ANIMALS? ___________________________________

HAS YOUR DOG EVER GROWLED OR SNAPPED AT ANYONE FOR TAKING FOOD OR TOYS AWAY? IF YES, PLEASE EXPLAIN: _____________________________________________________________________________________

HOW DOES YOUR DOG REACT WHEN STRANGERS APPROACH THE HOME OR YARD OR OUT IN A PUBLIC PLACE?

_____________________________________________________________________________________________

IS YOUR DOG AFRAID OF ANY TYPES OF OTHER DOGS? DOES YOUR DOG PLAY OFF-LEASH WITH OTHER DOGS?

_____________________________________________________________________________________________

HOW DOES YOUR DOGS REACT WITH PUPPIES / OLDER DOGS? _________________________________________

HAS YOUR DOG EVER GROWLED AT SOMEONE? IF YES, PLEASE EXPLAIN: _________________________________

_____________________________________________________________________________________________

HAS YOUR DOG EVER BITTEN SOMEONE OR ANOTHER DOG? IF YES, PLEASE EXPLAIN: _______________________

_____________________________________________________________________________________________
HAS YOUR DOG HAD ANY TRAINING? (PLEASE CHECK ALL THAT APPLY)

NO TRAINING OBEDIENCE TITLES / AWARDS

TRAINED YOURSELF AGILITY

PUPPY KIDERGARTEN PRIVATE TRAINING SESSIONS

GROUP CLASS BASIC TRAINING OTHER: ________________________________

GROUP CLASS ADVANCED TRAINING
IS YOUR DOG SENSITIVE ABOUT ANY OF THE BELOW BODY PARTS? IF YES, PLEASE EXPLAIN.

TAIL: _________________________________________________________________________________

PAWS: ________________________________________________________________________________

HINDQUATERS: _________________________________________________________________________

NAILS CLIPPED: __________________________________________________________________________

BEING BRUSHED: ________________________________________________________________________

HIP PROBLEMS; IF YES, PLEASE ADVISE OF ANY RESTRICTIONS IN YOUR DOG’S ACTIVITIES OR MOVEMENTS: _______ _________________________________________________________________________
ARE THERE ANY PHYSICAL PROBLEMS OR DISABILITIES WHICH MAY AFFECT YOUR DOG IN DAYCARE? IF SO, PLEASE EXPLAIN: _______________________________________________________________________________
HOW MUCH EXERCISE / PLAY TIME DOES YOUR DOG RECEIVE NOW? ____________________________________
WHAT IS THE MAIN REASON THAT YOU HAVE CHOSEN DOGGY DAYCARE FOR YOUR DOG? ___________________

_____________________________________________________________________________________________
ARE THERE ANY OTHER ISSUES OR CONCERNS THAT YOU FEEL SHOULD BE ADDRESSED WHILE YOUR DOG IS AT DAYCARE? IF SO, PLEASE ADVISE AND LIST OF IMPORTANCE.

ISSUE VERY SERIOUS SERIOUS NOT SERIOUS

1.___________________________________________________________________________________________

2.___________________________________________________________________________________________

CERTIFICATION: HEALTH AND TEMPERMENT
I, __________________________________________, HERBY CERTIFY THAT MY DOG(S) _____________________ ARE IN GOOD HEALTH AND HAVE NOT BEEN ILL WITH ANY COMMUNICABLE DISEASES IN THE LAST 30 DAYS. I FURTHER CERTIFY THAT MY DOG(S) HAVE NOT HARMED OR SHOWN AGGRESSIVE BEHAVIOR TOWARD ANY PERSON OR ANY OTHER DOG.
VACCINATION DATES WHO ADMINISTERED THE VACCINATION SHOTS?

DHHP* SHOT: _______________________ _______________________________________

RABBIES SHOT: ______________________ _______________________________________

BORDATELLA SHOT: ___________________ _______________________________________

FECAL SAMPLE DATE TESTED: ___________ ________________________________________

(DHHP*DISTEMPER, HEPATITIS, PARAINFLUENZA, PARVOVIRUS)
DOES YOUR DOG HAVE ALLERGIES (FOOD, ETC)? _____________________________________________________
HAS YOUR DOG HAD FLEAS OR TICKS IN THE LAST YEAR? IF SO, PLEASE EXPLAIN:____________________________

_____________________________________________________________________________________________

IS YOUR DOG ON ANY FLEA OR TICK PREVENTION? ___________________________________________________

IS YOUR DOG ON ANY HEARTWORM PILLS? _________________________________________________________
SIGNATURE OF OWNER:____________________________________________ DATE:_______________________

SIGNATURE OF OWNER: ____________________________________________ DATE:_______________________

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