Daycare Profile Form

Daycare Profile Form

Daycare, Training, Grooming
Owner Information
Parent Name*

First NameLast Name
Secondary Parent Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Mobile Number*

Area CodePhone Number
Secondary Number

Area CodePhone Number
Email*
example@example.com
Emergency Contact Name (other than yourself)

First NameLast Name
Emergency Contact Phone

Area CodePhone Number

Daycare Profile Form

Daycare, Training, Grooming
Pack Member Information
Dog's Name*
Breed*
Color(s)*
Weight*
Birthday*
Sex*

MaleFemale
How long has your dog been in the family? *
Primary Veterinary Hospital *
Primary Veterinarian (you can write "general" if no primary)
Is your dog spayed or neutered? (dogs older than 6 months must be altered prior to daycare)*

YesNo
If "no" please provide date, if scheduled, or age.
NOTE: If your dog is older than 6mo old we will require that they are spayed or neutered before starting daycare. If they are younger than 6mo old we can enroll them until they reach that age marker, then they will sit out until they are altered. Dogs may require a second evaluation to re-enroll in daycare if they are out for more than 2 months.
Personality
Describe your dog's play style: *
Is your dog crate trained? *
Note: we do not crate for nap time at The Wiggle Room. We will occasionally use a crate for a break if a dog needs some quiet time.
Is your dog comfortable with being handled? *
Are there any sensitive areas on your dogs body? *
Does your dog have separation anxiety? *
If so, please describe;
Does your dog have leash reactivity? (ie; friendly off leash but will growl/lunge while on leash)*
Does your dog resource guard? This can include food, water bowls, toys, or affection. *
Has your dog ever growled/snapped/bitten any dog OR person that has touched their food/water bowl/toys/bones OR for any other reason? *
If so, please explain;
Has your dog ever climbed a fence? *
If so, how high?
Describe any other behavioral quirks or sensitivities we should be aware of;
Does your dog tend to mount other dogs, in play or otherwise?
Social Level

Not all dogs are ready for this level of socialization! Many can grow out of daycare or find it too overwhelming. These questions can help us gauge how ready your pup is to play!
Does your dog play with other dogs on a regular basis? (not including other dogs that live in the home)*
Describe your dogs level of socialization; (ie; plays at parks/play groups often, shy, etc)*
How many dogs is your dog used to playing with at one time? *
When was the last time your dog played in a group play environment? (parks, playdates, daycare, etc)*
Has your dog ever attended a daycare environment before?*

YesNo
If so, how long ago?
Were there any issues reported?
Does your dog automatically dislike any kind of person OR dog (men, elderly, children, larger/smaller dogs, puppies)? *
What is your main reason for daycare? *
Are you looking for full days of daycare, half days, or either?*
If your dog is unable to do a full day, due to play style or anxieties etc., are you able to start with half days?*
How did you hear about us?
Medical Information
Is your dog current on preventative medication? (heart worm and flea/tick)*

YesNo
What flea/tick and heartworm prevention do you use? *
Does your dog have any known allergies? (please list)*
Does your dog suffer from arthritis or joint issues? *
Has your dog ever has a cruciate repair or other major surgery? *
Is your dog on any medications other than monthly preventative? *
Please list any other issues we should be aware of;

Client Contracts

Please read and initial or sign where indicated
Rules & Regulations

Age/Breed: Any age or breed of dog is allowed at The Wiggle Room as long as they meet the facilities temperament, vaccine and health requirements. Puppies cannot begin until all vaccination series are complete, usually by 16 weeks old. All dogs must be spayed or neutered unless under 6 months of age.

Vaccinations: All dogs must have up-to-date vaccine records. Parents must submit a printed copy of verification from their veterinarian that their dog is current on Rabies, Dhlpp (Distemper) and Bordatella (Kennel Cough) vaccinations and they must have a negative fecal in the past year, which includes a Giardia test.

Health: All dogs must be in good health to attend The Wiggle Room. Parents will need to certify that their dog is in good health and free from any condition that could possibly put other daycare guests at risk. Dogs who have been sick with a communicable condition in the last 30 days will require a veterinarian certification of good health to attend The Wiggle Room. If at any time during care a dog is noticed to have fleas or ticks they may be sent home from daycare immediately. They will be allowed to return 48 hours after treatment has been applied (see recommended topical treatments). We highly recommend a flea and parasite preventative, excluding over the counter flea/tick collars. Diarrhea or puppy warts may also be reason for early dismissal. No dog is allowed to attend with an open wound, stitches, bandage, cone, or staples.
Recommended products: Advantix, Frontline, Revolution, Seresto Collar, Interceptor, Heartgard, Revolution.

Belongings/Feeding: All dogs are required to wear a “quick release” clip-buckle type collar with a nametag. No belt-buckle collars. Please no retractable leashes, prong collars, or electric collars. Personal items are not allowed, as they can get destroyed. Please feed your pup prior to drop off, meals are not provided at The Wiggle Room.

Temperament Assessment: All dogs must pass The Wiggle Room temperament and behavior assessment. All dogs must be non-aggressive and not bowl, food or toy possessive. The temperament test can be scheduled AFTER all paperwork is submitted. Behavior monitoring is ongoing daily as dogs can grow out of daycare.

Hours of Operation: Monday through Friday 7am to 6pm, Saturday 8am-5pm. Morning drop offs must be checked in by 9:30am. Late drop offs may be arranged with advanced notice, but not guarenteed. Half day pick up is at 12:30pm. Full day pick up is anytime after 1pm. The Wiggle Room closes promptly at said closing time. Late fees of $1.00 per minute will apply. If there is an emergency and you are running late please call ASAP. The Wiggle Room also offers transportation services in the morning, afternoon, and evening. Please call ahead to schedule.

Fees: Payable each day upon pickup. Discounted packages are available for full and half days. All pre-paid packages are non-refundable and non-transferrable. Full day package days cannot be split into two half days as they are already discounted. A 7% sales tax is required per RI law. Please see the website for more pricing information.

Daycare Reservations: REQUIRED. Cancellations are not penalized, however notifying staff as soon as possible is preferred so that we are not expecting your pack member.

Although it is supervised play, your dog may come home with an occasional nip or scratch. Dogs can play ruff!
*please see website for more FAQs and general information
Wiggle Waiver

Please read carefully
- Every dog reacts differently and animals, by nature, are unpredictable and, therefore, present a certain level of risk. I acknowledge and understand that there are certain risks involved in participating in daycare and in owning, training, caring for, handling and being in the presence of dogs, including but not limited to injuries to people, property, and animals resulting from dog fights, dog bites to humans or other dogs and the transmission of disease.
- I understand that my dog must be leashed at all times when entering and exiting The Wiggle Room.
- I hereby waive and release The Wiggle Room, its employees, owner and agents, from any and all liability that my dog may suffer or cause, including specifically, but not limited to, any injury, sickness or damage whatsoever arising from the attendance and participation at The Wiggle Room.
- Due to the social nature of our facility there are some inherent risks. These risks include, but are not limited to: transfer of communicable diseases such as Canine Papilloma virus (Puppy Warts), Canine Cough/Kennel Cough, parasites, broken nails, sore feet, abrasions, and cuts. Most of these risks can be managed by staff or at home, in some cases veterinary care may be required. The Wiggle Room takes all precautions to severely limit these risks.
- Dogs at play during daycare get dirty. Dogs with longer hair can get matted from the level of activity at daycare.
- Excessively long toenails may cause injury. I will be notified if my dog’s nails are too long. Nails must be trimmed by the next visit.
- Dogs not regularly exposed to the level of activity at the daycare may feel the discomfort of sore muscles, sore joints and fatigue, and dogs not regularly exposed to outside activity or play on hard surfaces may experience sore paws, blisters, bruises or abrasions on the feet.
- If a dog has been away from the pack for a significant period of time a second temperament test may be required to ensure it is still a good fit. Additionally, dogs not familiar with The Wiggle Room may experience separation anxiety when apart from their human companions.
- I understand that photos may be taken of my dog while in daycare or grooming, and these photos may be shared on social media pages for The Wiggle Room.
- Dogs can grow out of wanting to play in a high-energy environment at any point in their life. Any behavior deemed dangerous or inappropriate by The Wiggle Room personnel may result in dismissal of my dog(s) from the program at any time. (e.g., bullying, aggressive play, excessive humping, anxiety, etc.)
- Water is available at all times; however, my dog may still be thirsty after daycare. I will be aware of their water intake as excessive amounts may cause an upset stomach or other problems.
- I must pay for all services at the time they are 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 take.
- I understand that payment for packages are non-refundable. If I do not use a full package it will not be refunded. Packages are non-transferrable.
- In admitting my dog(s) into The Wiggle Room, the facility has relied on my representation that my dog(s) is/are in good health, has/have not been ill with any communicable disease within the last 30 days and has/have not harmed or shown aggressive or threatening behavior towards any person or any other dog.
- I understand that The Wiggle Room’s employees give all pets involved in any type of incident a cursory examination; however, the facility’s staff are not trained veterinarians and will not be liable for the location, treatment or diagnosis of any injuries incurred on the premises. If my dog(s) is/are involved in an incident at The Wiggle Room, I will check my dog(s) further or seek treatment for my dog(s) by a licensed veterinarian at my discretion and cost.
- I have read and understand The Wiggle Rooms “Rules and Regulations” which outline all vaccine/health requirements, collar requirements, hours of operation, pick-up/drop-off times, reservation requirements and fees.
- In case of a medical emergency, I understand that full effort will be made to reach me, or my emergency contact. However, if unable to, I give full permission for The Wiggle Room to make any needed decision concerning medical treatment of my dog(s). I authorize urgent veterinary treatment of my animal(s) and I understand that I will be fully responsible for all fees and charges incurred on my behalf. The Wiggle Room reserves the right to utilize the services of any available veterinary hospital in the case of such emergency.
Rules, regulations, and contract subject to change at any time without notification.
I have read the Rules & Regulations and Client Waiver *

Clear
Date*

MonthDayYear
Date
Vaccine Record Information
Please provide your dogs vaccination record for Rabies, Dhlpp (distemper including Lepto), Bordetella (kennel cough), and a negative fecal test, including Giardia, within the past year. You or your veterinary hospital can email this information via PDF or JPEG (a clear photograph is acceptable) to info@thewiggleroomri.com*

I understand I will need to submit my dogs vaccine and fecal information. The Wiggle Room will NOT contact you until we receive this information.
The Wiggle Room does not take visiting tourist dogs.

If you are visiting for more than one month please call to see if we can accommodate you.

Thanks!
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Daycare Profile Form

Owner Information

Daycare Profile Form

Pack Member Information

Personality

Social Level

Medical Information

Client Contracts