ULTIMUTT Daycare Application

Ultimutt Knoxville Daycare Application

Please fill out the form entirely, one for each pet, and we'll add your dog to the waiting list for daycare. Dogs must attend daycare at least one day a week to keep them comfortable in our daycare environment.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
We communicate primarily through email. What is the best method for initial contact about this daycare request?

TextCallEmail
Dog's Name*
Dog's Date of Birth (or best guess)*

MonthDayYear
Approximate Weight*
What is your dog's breed? (or best guess)*
What is your dog's sex?*
How old was your dog when he/she was spayed/neutered? *Note: dogs not spayed or neutered after 6 months will not participate in group play for their safety until after their surgery.*
If Intact, type Not Yet
Color / Description*
Upload a current photo of your dog here
How long have you had your dog? (We recommend that dogs spend at least 2 weeks acclimating to their new home before introducing them to daycare)*
How often would you like to bring your dog to daycare? Dogs must attend daycare at least one day a week to keep them comfortable in our daycare environment. *
Where did you get your dog?*
Are there other pets in your household? If so, list name, type and age.*
Emergency contact name and phone number*
Authorized caretakers name(s) and phone number(s)*
Medical History and Information
What veterinary clinic do you use?*
Veterinary clinic phone number*
VACCINATIONS

We require proof of the following:

• *Bordetella (the intranasal 6 month that includes Adenovirus, Parainfluenza, and Bordetella is highly recommended)

• *Canine Influenza (H3N2 or H3N2/H3N8.The combination vaccine is highly recommended. Both the first shot and booster required before attending.)

• Rabies 1 year or 3 year (once old enough for puppies)

• DHPP annual or equivalent (or puppy series)

*The first two are not part of the regular vaccines routinely given and have to be asked for. There may be a 14 day waiting period after receiving some vaccinations before attending daycare.
My dog has the following vaccinations - up to date!*

DHPP or equivalentRabiesBordetellaCanine Influenza
Does your dog have any food allergies or skin conditions?*
If None, type None
Are there any places your dog does not like to be touched?*
If None, type None
Is your dog afraid of any of the following?*

ThunderstormsFireworksMost Loud NoisesWind/RainNoneOther
Personality, Preferences, and Past Experiences
Which 3 adjectives best describes your dogs personality?*

CalmEasy-GoingInquisitivePatientAffectionatePlayfulGoofyWorriedNeedyBossyProtectiveIntenseVocal
Which best describes your dogs energy level?*

LowMediumHIgh
How would you describe your dog's play style with PEOPLE?*

FetchTug of WarWrestlingNo ThanksOther
Are there any types of PEOPLE that your dog dislikes? Please explain.*
If Not, type None

How does your dog initially act in these situations:*

	Fearful	Submissive	Relaxed	Dominant	Don't know
Greeting a stranger in Public
Interacting with Veterinarian or Vet Tech
When a person reaches for your dog's collar or head
Being touched or approached with owner present
When hugged or lifted
When a person takes food, toys or prized objects
Interacting with other family dogs
Passing a calm dog on a leash
Passing an excited or barking dog on a leash
At a dog park or other social setting

Which obedience cues/skills does your dog respond to consistently?*

ComeOff/Don't jumpSitDownStayLeave ItOther
Does your dog have any problems in the following areas:*

MouthingJumping/Mounting other dogsNot house brokenBarkingChewing beddingDestroying toysEating rocks/foreign objectsHas sensitive pawsClimbing fencesIgnoring commandsOther
Is your dog crate trained? (crating is required for nap times)*

Yes, using every dayNo, have never triedYes, but it's been a whileBad in a crateUnknown
Doggie Daycare

Please complete the following questions to help us learn more about your pup for daycare!
Does your dog use pee pads in the home?*

YesNo
Hybrid Day Camp Option

We are now offering a Hybrid Daycare option for our adult play groups. The camp involves enrichment activities in the mornings and the afternoon is group play. Our regular Day Camp and Solo Day Board options are also available. Check out our website for more information.
Which of our programs and services are you most interested in for your dog?*

Dog Daycare / Group PlayHybrid Camp (1/2 Enrichment + 1/2 Group Play)Puppy Daycare (includes enrichments)Ultimutt University Beginner Obedience TrainingFitness and ExerciseWeight LossTreadmillOther

How does your dog initially act in these situations:*

	Fearful	Submissive	Calm	Excited	Barking	Dominant	Aggressive	Don't know
Meeting a new dog at the Vet, pet store or park
Greeting a puppy
Greeting a small group of dogs (2-3)
Greeting a large group of dogs (4+)
When another dog takes food. toys or a prized object
Watching a person with lawn equipment or a bicycle

How would you describe your dog's play style?

King of the hillWrestle ManiaLikes to be chasedLikes to chase othersShares toys/ballsTug of warDon't knowOther
Which categories of dogs does your dog interact consistently well with?

MalesFemalesSmall dogsMedium dogsLarge dogsCalm dogsRowdy dogsOther
Are there any categories of dogs your dog automatically dislikes?*

NoYesIf yes, add here
Has your dog ever attended another doggie daycare? If yes, where?

NoYesIf yes, add here
Has your dog ever bitten anyone?

NoYesIf yes, please explain

Please tell us about any altercations/fights your dog has had when interacting with other dogs or people:*

	No Altercations or Fights	Altercations/ Fights But No Injuries	Dogs/People injured. Medical Treatment NOT Needed	Dogs/People injured. Medical Treatment Needed
At Home
In the Neighborhood
At a Friend's House
At the Vet, in a Store or Park
Off-Leash at a Dog Park
At Another Dog Daycare

Have you ever noticed your dog staring at or stalking another animal?*

NoYesIf yes, please explain
Final Details

Just a few more simple questions
Please provide other comments or information about your dog that you feel might be helpful:
How did you hear about us?*

Internet SearchFacebookInstagramFrom my VetWord of Mouth/From a FriendOther
If referred by a friend, please tell us who so we can thank them:
Image Release*

I grant permission to post pictures of my dog(s) with their name on Ultimutt Knoxville website, on our public social media (Facebook, Instagram, etc.) and/or in other print and video/TV media related to Ultimutt Knoxville.I grant permission to post pictures of my dog(s) without their name on Ultimutt Knoxville website, on our public social media (Facebook, Instagram, etc.) and/or in other print and video/TV media related to Ultimutt Knoxville.
WAIVER
1. I understand this is a facility where my dog(s) may engage physically with other dogs in daycare.
2. I understand that my dog(s) may be subject to injury, muscle fatigue, and/or sore pads due to excessive play during daycare.
3. I understand that dogs are unpredictable and may behave in ways that subject themselves and other dogs to risks in this facility, even if all dogs have been previously assessed for good temperament.
4. I understand that misters and baby pools are used during warm weather to keep the dogs cool. My dog may be damp or wet when picked up.
5. I hereby certify that my dog(s) is/are in good health and has not been ill with any communicable condition in the last 30 days.
6. I understand that I am solely responsible for any harm caused by my dog while my dog is attending Ultimutt Knoxville Inc. I further certify that my dog has not harmed or shown aggressive or threatening behavior towards any person or any other dog. No dog may be admitted that shows any signs of any type of aggression.
7. My dog has not been exposed to rabies, distemper, Bordetella, canine influenza or any other contagious or communicable disease within a thirty-day period prior to being left for Daycare, grooming, training or other add-on services. I agree to notify Ultimutt of any exposure to any virus, infection or other transferable illness and will not bring my dog to Ultimutt until he/she is symptom free for a reasonable period to be determined by my dog’s veterinarian or until written approval is obtained from a veterinarian. I further agree not to bring my dog to the Facility if he/she is exhibiting signs of illness that may be harmful to other dogs in attendance, such as: vomiting, diarrhea, extreme lethargy, etc. without first obtaining approval from Ultimutt Knoxville.
8. I hereby release and agree to save and hold harmless Ultimutt Knoxville Inc, its directors, officers, shareholders, employees, assistants, members and agents from any and all liability, claims, suits, actions, loss, injury, or damage of any nature or kind, or for any liability claims, suits, actions, loss, injury or damage which I or my dog may sustain, or which may be caused in any way by my dog. I specifically, without limitation, agree to fully indemnify Ultimutt Knoxville Inc for any and all such liability, claims, suits, actions, losses, injury, or damage.
9. I hereby agree to pay veterinary / medical expenses incurred because of injury caused by my dog(s). I give Ultimutt Knoxville Inc permission to seek veterinary care if necessary, for my dog(s) at my expense, however, I will not hold Ultimutt Knoxville Inc responsible if they fail to seek veterinary care.
10. I certify that I have read and understand the policies of the Utimutt Knoxville as set forth and understand the conditions, statements of this agreement.
11. Owner hereby certifies that Owner has read and understands this Waiver and Release of Liability and the regulations set forth above. By signing this agreement, Owner agrees to be bound by its terms and conditions.
By e-signing this form, I accept the risks in the statements in the waiver above and I certify that the information provided in this form is accurate and true to the best of my knowledge. *

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Ultimutt Knoxville Daycare Application

Doggie Daycare

Hybrid Day Camp Option

Final Details