Mighty Pet Day Camp and Lodge Enrollment Form

Owner Information

Full Name*

First NameLast Name

Full Name

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Secondary Phone Number

Area CodePhone Number

E-mail*

How did you hear about us?*

If other please state

Dog Information

Dog's Name*

Breed*

If a mix breed, list two possible predominant breeds

Date of Birth or Age*

Color*

Gender*

MaleFemale

How long have you owned the dog?*

Has Your Dog Been:*

SpayedNeuteredNone of the Above

Why are you considering our doggie day camp program for your dog?*

Which of the following best describes your dog's level of interaction with other dogs?*

None-no knowledge of other dog interactionMinimal-on leash encounters onlyModerate-Some off-leash playtime on occasion with visitor's/neighbor's/friend's dogExtensive-Regular dog interactions such as dog parks, dog daycare, social events, etc.

Has your dog had any problems previously in an off-leash social environment.*

NoYes

If yes, please check all that apply*

Altercation or fight at a public dog parkAltercation or fight with a neighbor or friend's dogFearful reaction in a group of dogsDismissed from a prior dog daycare, social playgroup program, or dog parkOther

What reason were you given as to why your dog was dismissed? Check each statement that applies to the situation that resulted in your dog's dismissal.*

My dog was injured, no medical treatment requiredMy dog was injured and required medical treatementAnother dog was injured, no medical treatment requiredAnother dog was injured and required medical treatmentA person was injured, no medical treatment requiredA person was injured and required medical treatment

Provide any other comments you want us to know about this situation.

Veterinary Information

Vet Clinic*

Veterinarian*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Proof of vaccination records from your veterinarian are required to participate in day camp, lodge, grooming, or training services at Mighty Pet as well as current flea and tick prevention.

Vaccination Dates:

Rabies:*

Date Vaccination Expires

Bordetella:*

Date Vaccination Expires

DHLP:*

Date Vaccination Expires

Flea and Tick Prevention:*

Date Prevention Expires

Please list any medical problems your dog has had or physical limitations:*

Please list any medications that your dog is currently taking.

Does your dog have any allergies? *

If yes please list them*

Can your dog have treats while attending Day Camp?*

If no, and you would like your dog to have treats, please send treats with your dog

Please list any any bathroom related issues or concerns that your dog may have?

What does your dog do for fun?

Check the box that best represents you dog's overall level of exercise routine:

Couch Potato- spends days sleeping, occasional walk and/or playtime with humans or other dogsMild Exercise-Short Daily Walks and/or regular playtime with humans or other dogsModerate Exercise-Long or multiple walks daily and/or regular playtime with human or dogsAthlete- Regular jogs/ runs and/or regular participation in dogs sport activities such as agility, disc dog, flyball, etc.

Behavior Information

Does your dog play with other dogs*

YesNo

If yes, which type? Check all that apply*

Are there any types and/or breeds of dogs that your dog seems to automatically fear or dislike?

How does your dog react to another dog approaching him/her in a park, on a walk or in public? Check all that apply to OFF-LEASH interactions.*

How does your dog react to another dog approaching him/her in a park, on a walk or in public? Check all that apply to ON-LEASH interactions.*

How does your dog respond to the following tasks?

Trimming Nails?*

Giving Pills?*

Grooming?*

Bathing?*

Patting Head?*

Grasp Collar?*

Being Lifted?*

Being Restrained*

Behavior Problems:*

Do you use a crate?*

YesNo

Does your dog like the crate?*

YesNo

Has your dog ever jumped or climbed a fence?*

YesNo

If yes, please describe the situation:

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

Please give additional information regarding fear or anxiety in your dog:

Describe situations where your dog appears fearful and/or aggressive:

If your dog struggles with separation anxiety. What are the circumstances that this behavior appears?

Do you ever muzzle your dog?*

YesNo

If so, for what reasons do you muzzle your dog?*

How does your dog respond to the following situations?

When Approached While Eating:*

When Approached With Treat Or Toy:*

When Dog Is Approached While Sleeping:*

To Other Dogs In Your Home:*

To Other Dogs Outside Your Home:*

When another dog approaches your dog while eating:*

When another dog approaches your dog while playing with a toy:*

Has your dog ever bitten a person?*

YesNo

Has your dog ever been reported to animal control for biting?*

YesNo

Please check any Mighty Pet training services that you are interested in:

1. All pets in lodging or attending day camp must be current on vaccinations and flea prevention. Written proof of vaccinations or verification with the pet's veterinarian must be provided before any pet is permitted to stay. If parasites are found on the pet during the stay, they will be treated as the staff deems appropriate, and the cost of the treatments will be at the owner's expense.

2. Mighty Pet requires all vaccinations to be administered by a licensed veterinarian. Vaccinations administered by anyone who is not a licensed veterinarian will not be accepted as valid.

3. All pets should be free from internal and external parasites such as fleas and worms. There should be no signs of contagious disease i.e. sneezing, coughing, vomiting, diarrhea, lethargy and/or discharge from the nose or eyes. Even if your pet does not seem sick, if they are displaying these symptoms do not bring them to day camp or lodge. They need to be seen by your veterinarian.

4. I understand that it is possible for dogs to transfer illnesses such as upper respiratory infections and kennel cough, even with the required vaccinations. This is similar to daycare for children where illnesses such as pink eye and the flu can be transferred from one child to another. All reasonable precautions will be used to prevent illness, injury and escape of the pet.The Lodge is not responsible for the actions of the pet that may cause injury, illness or escape.

5. Urgent Care and Emergency Medical Procedure: In the event that pet(s) need urgent care or emergency medical attention the Lodge will first attempt to contact the pets owner. If the pets owner cannot be reached the Lodge will then attempt to reach the emergency contact(s) listed by the pets owner. If the emergency contact cannot be reached the Lodge will call the pets local vetrinary clinic. If after attempting to call and no persons are reached the Lodge will continue this procedure until a response is recieved. Because there is no local emergency vetrinary clinic if the Lodge is unable to reach the following contacts, I understand that pets treatment may be delayed. To avoid delaying treatment of pets make arrangements with emergency contact(s) and infrom pets vetrinary clinic that pets will be in the Lodge's care.

6. I understand that in the event that pet(s) need urgent or emergency medical care and need to be transported to an emergency vetrinary clinic that it will be the owners responsibility to arrange transportation with the emergancy contact person.

7. Any lodging or day camp attendee may be dismissed at any time if deemed contagious, dangerous or aggressive towards the staff or other animals.

8. The pet owner is responsible for the spaying or neutering of pets. The Lodge is not held responsible in the event of accidental insemination and is not responsible for any charges incurred due to insemination.

9. All dogs staying longer than 7 days will be bathed prior to discharge as a complimentary service. However, if the pet's health or temperament makes it hazardous to the staff or the pet, the pet will not be bathed.

10. If the pet is to be picked up by someone other than the owner, arrangements must be made with the Lodge regarding the name and contact information of the person picking up and payment information.

11. All pets not picked up within 7 days after the expected date of pickup will be considered abandoned. The Lodge is given authorization to remove the pet(s) from the facility as they see fit, including adoption, turning over to animal control, or surrendering to the Menominee Animal Shelter.

12. I give the Lodge permission to take images and/or video content of my pet(s) and use them on social media, the website, and in various Mighty Pet promotions.

13. This document is effective for any and all lodging and day camp visits until the owner requests otherwise in writing.

PLEASE CHOOSE ONE OF THE FOLOWING REGARDING THE TYPE OF TREATMENT OF MY PET IN THE THE CASE OF AN EMERGANCY WHEN THE OWNER OR EMERGANCY CONTACT CANNOT BE REACHED. THIS WILL BE SENT WITH PET WHEN RECIEVING TREATMENT:*

A. Treat my pet as needed. Do any and all diagnostic tests, treatments, and surgeries necessary for the well-being of my pet. I accept full financial responsibility for all charges related to the treatment of my pet.B. Treat my pet as needed, but do not exceed $ . I understand that if the proposed treatment exceeds the amount designated, and I or my agent cannot be contacted, my pet will NOT receive further medical treatment EVEN if it is life threatening. I understand that if the veterinarian and their agent(s) feel that my pet is undergoing needless pain and suffering due to the lack of medical care, and the treatment and tests needed would exceed the above amount, the veterinarian and their agent(s) are authorized to euthanize my pet. I will be held responsible for all charges incurred during that time period.C. Do NOT administer any treatment to my pet until someone is reached. I fully understand the consequences to my pet if treatment is witheld. I understand that if the veterinarian and their agent(s) feel that my pet is undergoing needless pain and suffering due to the lack of medical care, the veterinarian and their agent(s) are authorized to euthanize my pet. I will be held responsible for all charges incurred during that time period.

IF CHOOSING OPTION B PLEASE INDICATE THE DOLLAR AMOUNT THAT TREATMENT WILL NOT EXCEED IN THE EVENT THAT EMERGENCY TREATMENT IS NEEDED $ blanks*

Signature*

By Electronically Signing Above And Clicking The Submit Button Below You Agree To The Above Terms

Mighty Pet Day Camp and Lodge Enrollment

Lodging and Day Camp Authorization Form