New Customer: Daycare/Boarding Intake Form

New Customer: Daycare/Boarding Intake Form
Thank you for your interest in our services at Dog Days Daycare Center!

Please fill out this form in its entirety and we will contact you shortly to schedule your assessment.

It will take approximately 20 minutes to complete this application.

Please be aware that our boarding services are only available to our customers who come regularily for daycare.
Section 1: Client Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Phone Number (Cellphone)*
Phone Number (Additional Owner Cell Phone)
Phone Number (Home)
Phone Number (Work)
Which of the above phone numbers is your preferred contact number?*
Primary E-Mail*
example@example.com
Email (Alternate)
example@example.com
Names of family members in your home and their relation to you.
ex. Jimmy Smith (son), Susan Smith (wife), etc.
How did you hear about us?

Section 2: Emergency Contact Information
Emergency Contact (If it becomes unsafe for the dogs to stay at the facility.)*

First NameLast Name
Relation*
Emergency Contact Phone Number*
Alternate Emergency Contact (If it becomes unsafe for the dogs to stay at the facility.)

First NameLast Name
Relation
Alternate Emergency Contact Phone Number
Please enter a valid phone number.

Section 3: Veterinarian Information
Veterinarian*
If other, who is your veterinarian?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Fax Number
Please enter a valid fax number.

Section 7: Owner Agreement
Dog Days Daycare Center, L.L.C. agrees to exercise due and reasonable diligence in the care of your dog and in keeping the facility properly enclosed and sanitary. Dog Days Daycare Center, L.L.C. is fully insured, and all dogs are cared for by Dog Days Daycare Center, L.L.C. staff without liability for loss or damage from disease, theft, fire, death, escape, injury or harm to persons, other dogs, or property, or for other unavoidable causes.

The owner of the dog agrees to indemnify Dog Days Daycare Center, L.L.C., its staff and agents against any claims made for losses or damages of any kind suffered as a result of any acts by his/her dog or as a result of his/her failure to inform Dog Days Daycare Center, L.L.C. of any pre-existing condition or disease the dog may have.

The owner of the dog agrees to take full responsibility for taking precautions against contagious illness and parasite exposure by consulting their own veterinarian, and accepts all reasonable risks of injury incurred in normal daycare and boarding activities. The owner also agrees to take full and financial responsibility for any damage or injury caused directly by the behavior of his/her dog to another dog, person or property.

The owner of the dog understands and agrees that in admitting his/her dog to Dog Days Daycare Center, L.L.C., the staff has relied on the owner’s representations that the dog is in good health and has not harmed nor shown aggressive or threatening behavior towards any person or other dog.

In the event of an emergency, Dog Days Daycare Center, L.L.C. staff will first attempt to contact the owner, followed by attempts to reach the emergency contact person designated. Contact with the owner’s designated veterinarian may also be made. If circumstances are deemed such that immediate medical treatment is necessary, Dog Days Daycare Center, L.L.C. staff retains sole discretion in determining the need for emergency treatment, without liability.

Owner agrees to pay a mandatory sum of $20 annually (on the anniversary of the first payment) to Dog Days Daycare Center, L.L.C. In consideration of such payment, should there be a medical emergency whereby Owner’s dog becomes ill or injured while at Dog Days Daycare Center, the dog will be transported by Dog Days Daycare Center staff to a veterinarian for treatment. Payment for the initial treatment, prescribed medications, and equipment provided by the veterinarian in the treatment plan will be paid for by Dog Days Daycare Center up to a maximum of $1,000 per occurrence. This plan, known as the Peace of Mind Program, should NOT be construed as insurance.

The owner recognizes that there are inherent risks of illness or injury when dealing with animals, and that dogs in the care of Dog Days Daycare Center are commingled. Such risks include, but are not limited to, nicks, cuts and scrapes due to the nature of the way dogs play, sore paws and muscles and canine cough.

All daycare and boarding charges are to be paid in advance. The owner understands that a $35 charge will be assessed for returned checks. Reservations are required. Cancellations with less than 24 hours’ notice and “no shows” will be charged full fees. The owner hereby agrees to the terms of this contract and recognizes that the provisions of this contract are binding on both parties.

The owner certifies that he/she is the owner of the dog being cared for by Dog Days Daycare Center, has read and understands the terms and conditions of this agreement and by initialing each paragraph, acknowledges acceptance of the terms and conditions.

Download the Owner Agreement here.

Section 8: Peace of Mind Program
As pet care service providers our highest priority is the health and well-being of your dog. While at Dog Days your pet receives the highest level of care. In the past, if your dog were to become ill or sustained an injury during his/her stay with us, we would have the dog treated by a veterinarian at your cost. Now, with our "Peace of Mind Program", while your dog is in our care we will have him/her treated by a veterinarian for any emergency illness or injury, usually at no charge to you.

There is an annual cost of $25 per dog for this mandatory program (cash or check only). If your pet becomes ill while in our care, we will transport the dog to a veterinarian of our choice (the dog's own vet whenever possible) for treatment. Dog Days Daycare Center will absorb the cost of the initial emergency treatment, plus any equipment or medications prescribed, up to a total cost of $1,000 per occurrence.

Example 1

Fido is with us for a day of daycare and four month old Fluffy grabs Fido's ear with her sharp puppy teeth, resulting in a tear in Fido's ear. We would immediately take Fido to the vet for treatment. Dog Days Daycare would pay up to $1,000 to have Fido's ear cleaned, sutured, and for the prescribed antibiotics, painkillers, and Elizabethan collar. Since the charges would be less than $1,000 there would be no cost to Fido's owner, nor to Fluffy's owner even though she caused the damage during play.

Example 2

Rover is boarding with us for the week. After dinner one evening we notice that he is bloating (a painful twisting of the stomach which is an extreme emergency). We whisk Rover off to the emergency vet where he immediately receives treatment, including the surgery his owner approved by phone to untwist the stomach. Rover survives the bloating episode with successful surgery and will still need a few days of hospitalization. The final bill will be more than $1,000. Dog Days will pay the first $1,000 of Rover's treatment and the owner will pay the rest.

We think you will agree that our "Peace of Mind Program" is well worth the $25 annual cost.

Be advised that the program is not, and should not, be construed as pet insurance, nor insurance of any kind.
The form is now complete.
Should be Empty:

New Customer: Daycare/Boarding Intake Form

Section 1: Client Information

Section 2: Emergency Contact Information

Section 3: Veterinarian Information

Section 4: Dog 1 Information

Questions

Section 5: Dog 2 Information

Questions

Section 6: Dog 3 Information

Questions

Section 7: Owner Agreement

Section 8: Peace of Mind Program