LRVC - Dog Daycare Registration

To be accepted into our day care program you must:

1. Be contacted by one of our Animal Care Coordinators upon completion of this form to go over setting up a daycare temperment evaluation

2. Meet our vaccination and temperament requirements.

3. Must be spayed/neutered if over 6 months of age.

Are you a current client of Lowell Road Veterinary Center?*

YesNo

Owner's Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Area CodePhone Number

Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Area CodePhone Number

Relationship to Owner

Others authorized to pick up my pet

Pet's Name*

Age of Pet*

Breed*

Approximate weight*

Sex*

MaleFemaleFemale SpayedMale Neutered

Current Veterinarian (if not Lowell Road Veterinary Center)

Clinic NameClinic Phone Number

Please upload your dogs current vaccines. All dogs must be up to date on Rabies, Canine Distemper (DHPP), Bordetella (kennel cough) and had a negative fecal test within the past 6 months. *Current clients of Lowell Road Veterinary Center may skip this question*

Browse Files

How did you hear about Lowell Road Veterinary Center's Dog Daycare?*

How long have you owned your dog?*

Where did you get your dog?*

Indicate the level of dog socialization that best describes your dog

None – No knowledge of other dog interactionMinimal – On lead encounters onlyModerate – Some off-lead playtime on occasion with visitor/neighbor/friend’s dog(s)Extensive – Regular visits to dog social events, off lead dog parks, doggie daycare, etc.

Has your dog had any problems previously in a dog daycare or other off-leash social environment?*

NoYes

Has your dog ever climbed a fence?*

NoYes

Is your dog on a flea, tick and heartworm preventative?*

NoYes

Has your dog ever been diagnosed with any orthopedic injuries (i.e ACL tears, Cruciate ligament injury, arthritis, dysplasia)*

NoYes

Does your dog have any other physical disabilities?*

NoYes

Does your dog have any allergies? (i.e food or environmental)*

NoYes

Does your dog have any allergies? (i.e food or environmental)? If yes, please specify.*

Would you like your dog to receive a daily Yappy Hour Treat before naptime when attending daycare?*

NoYesNot Sure / Need Further Information

Is your pet taking any medications? If yes, please specify medication(s) and the condition being treated:*

Are there any particular types of people your dog seems to automatically fear or dislike?*

NoYes

Has your pet ever bitten a person?*

NoYes

Is your dog frightened by anything? (i.e thunderstorms, fireworks, yelling)?*

NoYes

Has your pet ever bitten another dog?*

NoYes

Has your dog had a problem in any of the following areas (select all that apply):*

Indicate the overall level of exercise that best describes your dog’s routine*

Couch Potato: Spends days sleeping, occasional walks and/or playtimesMild Exerciser: Spends days outdoors, short daily walks and/or regular playtimesModerate Exerciser: Long or multiple walks daily and/or regular playtimesAthlete: Regular jogs/runs and/or regular participation in a dog sport activity such as agility, flyball, Frisbee, etc

PHOTO RELEASE: I grant Lowell Road Veterinary Center (LRVC), it's representatives and employees the right to take photographs of me and/or my pet, and to copyright, use and publish the same in print and/or electronically. I agree that LRVC may use such photographs of me and/or my pet with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and web content.*

YesNo

Do you have any other comments or information about your dog that might be helpful?

DAY CARE TERMS AND CONDITIONS: To ensure the health and safety of your dog and all other guests, we require that all of our clients agree and comply with the following terms and conditions:

1. I specifically represent to Lowell Road Veterinary Center (LRVC) that I am the legal owner of my dog. In addition, my dog is healthy, meets LRVC's vaccination standards, has not harmed or shown aggression or threatening behavior towards any person(s) or other dog(s) and has not been exposed to any known communicable disease within the 30 days immediately prior to admission to day care. I further represent that each time my dog is brought to BVMC, I will be recertifying that my dog is in good health and has not had any communicable illness of any kind for 30 days prior to admission. I further agree to inform LRVC of any changes in my dog’s condition and/or behavior prior to any day care visit.

2. I understand a Daycare Reservation is to be completed 24-48 hours before dropping off my pet for daycare. There is an additional fee that may be applied to the daycare charge if no reservation was received, if there is availability for your dog to stay.

3. I understand daycare drop off is between offered between 7:00-9:00AM and pick up is between 3:00-5:45PM. There is no availability to drop off or pick up between 10am-3pm. Dogs not picked up by closing time (5:45 P.M.) will be charged $10.00 for every 15 minutes after 5:45 P.M.

4. I understand that my dog is required to be fully vaccinated (including distemper, parvo, rabies and bordetella) and have a negative fecal test every 6 months, and I will provide BVMC with proof thereof from my veterinarian. I acknowledge that it is my responsibility to ensure that my dog continues to be fully vaccinated and that BVMC reserves the right to refuse daycare services if it is not fully vaccinated.

5. I understand that my dog must have flea/tick protection. I understand that my dog will be inspected for fleas when entering BVMC, and will be refused entrance if fleas are found. I further acknowledge that BVMC shall not be held responsible if my dog contracts fleas while at BVMC as proper flea protection is my responsibility.

6. I understand that the leash-free environment at LRVC provides dogs the opportunity to play in close physical contact, including with their teeth and paws. I acknowledge that no amount of supervision or personalized care by LRVC, its agents or employees, can prevent the possibility of injury or illness to my dog.

7. I agree to indemnify and hold harmless LRVCfrom any and all claims, liabilities, costs and expenses, including court costs and attorney fees, arising out of any harm or injury caused by my dog to other dogs or persons. I authorize BVMC to do whatever is deemed necessary for the safety, health and well-being of my dog and I agree to assume full financial responsibility for any and all medical expenses incurred. I expressively waive and relinquish any and all claims against LRVC, its employees, agents, and representatives for any injury, illness, or harm to my dog. Under no circumstances will BVMC be liable for consequential damages or damages beyond the replacement value of my dog.

8. I understand LRVC reserves the right to refuse admittance to any dog that displays signs of untreated or potentially contagious conditions, demonstrates aggressive behavior, or who fails our standard health and temperament policies. I further understand and agree that any problems that develop with my dog will be treated as deemed appropriate by the staff of BVMC, in their sole discretion

9. In the event any provision of this agreement is declared by a court of competent jurisdiction to be unenforceable, the remaining provisions shall remain in full force and effect. I certify that I have read, understand, and agree to be bound by the terms and conditions as set forth herein.

I acknowledge that I have read, and do hereby accept the terms and conditions contained in this agreement.*

First NameLast NameDate

Signature

Dog Daycare Registration

General Information

Health

Behavior