Daycare Profile Form

Daycare Profile Form

Daycare, Boarding, Training
Owner Information
Parent Name *

First Name Last Name
Secondary Parent Name

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Primary Mobile Number *

Area Code Phone Number
Secondary Number

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

First Name Last Name
Emergency Contact Phone

Area Code Phone Number

Daycare Profile Form

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

Male Female
Is your dog spayed or neutered? *

Yes No
If "no" please provide date if scheduled
*If your dog is older than 6mo old we will require that they are spayed or neutered before starting daycare. If they are 4-6mo old we can proceed until they reach that age marker.
Primary Veterinary Hospital *
Primary Veterinarian (you can write "general" if no primary)
How long has your dog been in the family? *
Is your dog comfortable with having their feet touched? *
Are there any sensitive areas on your dogs body? *
Has your dog ever climbed a fence? *
If so, how high?
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) *
Has your dog ever attended a daycare environment before? *

Yes No
If so, how long ago?
Were there any issues reported?
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;
Does your dog automatically dislike any kind of person OR dog (men, elderly, children, larger/smaller dogs)? *
Does your dog have separation anxiety? *
Describe any other behavioral problems or sensitivities we should be aware of;
What is your main reason for daycare? *
How did you hear about us?
Medical Information
Is your dog current on preventative medication? *

Yes No
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 unless the dog is boarding.

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 can be arranged with advanced notice. Half day pick up is at 12:30pm. Full day pick up is anytime after 2pm. 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. Discounts for extended boarding rates are available. 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.
I have read the Rule and Regulations above (please initial) *

Clear
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 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.
- 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 the cancellation and deposit policies for both daycare and boarding, and acknowledge that I may be responsible for a cancelation fee for not providing sufficient notice.
- 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.
E-Signature *

Clear
Date *

Month Day Year
Date
Vaccine Record Information

If you have your dogs vaccine records you may upload them below with either option.

You or your veterinary hospital can also email them to info@thewiggleroomri.com.

Please upload proof of: Rabies, Dhlpp (distemper), Bordetella (kennel cough), negative fecal in the past year.
Option 1. Upload Vaccine Images
I understand I will need to submit my dogs vaccine and fecal information *

I have uploaded this to this form I will email or call the vet to send this separately (we will not contact you until this is received)
The Wiggle Room does not take tourist dogs.

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

Thanks!
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

Daycare Profile Form

Owner Information

Daycare Profile Form

Pack Member Information

Medical Information

Client Contracts