Creek Dog Daycare Sign up Form

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Dog’s info

Dogs name Breed

Age Sex

Is this dog spayed/neutered?

YesNo, but under 8 months oldNo, dog is over 8 months oldNo, I don’t plan to alter my dog

*optional* 2nd Dog’s info

Dogs name Breed

Age Sex

Is this dog spayed/neutered?

YesNo, but under 8 months oldNo, dog is over 8 months oldNo, I don’t plan to alter my dog

Has your dog had any previous boarding or daycare experience?

When would you like do meet & greet? All day care dogs must do behavior evaluation to join.

Date

Time

Hour Minutes

AM/PM Option

When are you interested in starting Daycare services?

Date

How often are you wanting to have your dog in day care?

Just whenever I need a random day (paid day of)Regularly 1-2 days a week (paid day of)I’m interested in the 3-day-week membershipI’m interested in the 5-day-membership

What days of the week are you interested in bringing your dog to us?

Preferred Drop Off Time

Hour Minutes

AM/PM Option

Does your dog interact with other dogs of different households, size and breed on a regular basis?

Has your dog had any reactive or aggressive behavior towards another dog in the past 3 months? If so, explain.

Has your dog ever shown separation anxiety symptoms before?

Panting/drooling while you’re awayScratching at doors when you're in another roomWhining/Barking when you’re in the other room or awayPaws at/Attempts to escape crate if you use oneNot eating while owner is awayMy dog hasn’t shown these signs before

Has your dog ever shown signs of resource guarding before?

Stops eating with people or another animal pass byEats notably faster when people or animal passes byBody blocks other animal from reaching ownerBody blocks other animals from certain spaces (food area, bed, crate, couch)Growls while eating or chewingHard Stares at other dogs when the approach a resource (toy, bone, bed, dog bowl)

Is your dog on flea & tick prevention (required for your dog to stay)

Yes, they have a flea/tick collarYes, we use a topical gelYes, we use a monthly pillNo, but we will add them before they join

Does your dog have any food allergies? We provide snacks that are usually lamb, beef, pumpkin based as we know chicken is a common allergy for dogs. If your dog does have a food allergy you may want to provide them with a snack.

We do some light manners training here in the afternoons! Does your dog need help with anything in particular?

Not Jumping on people/me when I come inGoing in the crate on commandNot Settling/Paces around the housePulling on the leashNot bursting out of doors when I walk throughPaying attention when I say their nameMy dog is a menace and probably needs all of this and some more!

Are you interested in our other services? Bundling & discounts may apply!

Puppy Preschool Day Training (dogs under 7 months)Day Training (dogs over 7 months)Overnight & Vacation Boarding ServicesGrooming Services (baths, deshedding, full grooms and trims)Creek Dog Bath Club (monthly bath subscription)AKC Canine Good Citizen Testing

Please list your current Veterinarian

Please submit your dogs vaccination records here or email them to kbdean@creeksidecanine606.com if you don’t have a copy handy.

INFORMED CONSENT, WAIVER, AND RELEASEFOR CREEKSIDE CANINE, LLC

I recognize that there are inherent risks of illness and/or injury when dogs are allowed to co-mingle and engage in canine pack behavior. Such risks include but are not limited to problems arising from rough play, chasing, ingesting found objects and kennel cough. I understand and agree that any problem or injury sustained while my dog is atCreekside Canine, LLC will be treated as deemed best by Creekside Canine, LLC staff. In the event of a serious medical problem, Creekside Canine, LLC's may consult veterinary

services at the expense of the owner.

I, the owner, agree I am solely responsible for any and all acts and behaviors of my dog(s) while in the care of Creekside Canine, LLC, and as such I shall pay any and all such expenses incurred promptly. I understand that I am responsible for any harm caused by my dog(s) while attending Creekside Canine, LLC. I shall indemnify Creekside Canine, LLC against any and all claims made against, or losses or damages of any kind sufferedby Creekside Canine, LLC or its members as a result of my failure to inform Creekside Canine, LLC of any medical conditions or behavioral issues or tendencies my dog(s) may have. I agree that in bringing my dog(s) to Creekside Canine, LLC, the facility has relied on my representations that my dog(s) are in good health and that they do not pose a health or behavioral threat to people or other dogs. Should my dog(s) exhibit inappropriatebehavior which is deemed to compromise their own or other dogs' safety or that of the staff, I understand that my dog(s) will be safely confined as necessary until the owner or their authorized representative can remove the dog from the premises. I agree that Creekside Canine, LLC will not be liable for problems, damage or injury caused by or to my dog(s I understand that Creekside Canine, LLC is fully insured and I releaseCreekside Canine, LLC, Kate Dean, or any members of said Creekside Canine, LLC from any liability arising from my dog(s) attendance and participation at Creekside Canine, LLC and further agree to Indemnify Creekside Canine, LLC, Kate Dean, or any members of said Creekside Canine, LLC for claims made against them arising out of my dog(s) stay at Creekside Canine, LLC. I acknowledge that my dog(s) may be placed in a kennel for 'time outs' for aggressive or unwanted behavior in addition to meal times and overnightsleeping. I also understand that when dogs engage in normal pack play, nicks and scratches often occur. While my dog(s) will be checked and attended to daily by Creekside
Canine, LLC staff, it is possible for minor injuries to be inadvertently missed. If a serious injury is sustained, I, or my authorized representative, will be notified as soon as possible, along with a veterinary service. I understand and agree that any problem or injury that arises with my dog(s) will be treated as deemed best by Creekside Canine, LLC. I understand that Creekside Canine, LLC provides cots, blankets, and bowls for all guests and it is at my own risk if I choose to bring any items including leashes, toys, beds, bowls, etc. I agree that if I chose to bring any personal belongings for my dog(s) during their visit, those items may be damaged, destroyed or misplaced, and Creekside Canine, LLC will not be held responsible. I understand that my dog(s) may be photographed and/or recorded while at Creekside Canine, LLC. All such images will be the sole property of Creekside Canine, LLC and may be used to advertise, promote or publicize the facility. I understand that if my dog(s) are left at Creekside Canine, LLC for a period of 72 hours beyond the agreed length of stay, without contact from myself or my authorized representative that the animals will be judged to be abandoned and the necessary steps will be taken to place them with the proper authorities.

Signature

Creek Dog Daycare Sign up Form

Full day Drop Off is from 7:30 - 9:00, Half Days are 7:30/8-12:30 or 12-5:30. All Pick Ups must be by 5:30.