Daycare. Playcare. Puppy Circle Intake Form

Playcare

We want your dog to be safe, while having fun.
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Our Playcare Yard is open Tuesdays to Saturdays from 10:00am to 6:00pm, and on Sundays from 8:00am to 8:00pm. It is closed on Mondays. It is important to pick up your dog on time as overtime fees may apply otherwise.

If your dog can take only specific treats, please bring them and hand them to our Puppy Moms and Dads. They will use those treats when playing and interacting with your dog. We also have dehydrated food treats available for sale at the front desk.

SAFETY NOTE: DOGS MUST BE LEASHED WHEN ON THE LOBBY FLOOR.
Owner's Name*

PrefixFirst NameLast Name
Phone Number*
Please enter a valid phone number.
Email*

Confirmation Emailexample@example.com
Address*

Address

Street Address Line 2

CityState / Province

Postal / Zip Code
You are welcome to upload a photo of your dog.

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What is your dog's name?*
What is your dog's breed?*
How old is your dog? (We reserve the right to refuse to accept your dog in Playcare on account of it being too young or too old.)*
Is your dog male or female?*

MaleFemale
Is your dog neutered/spayed?*

YesNo
Name of your dog's yaya/driver/handler

First NameLast Name
Phone number of your dog's yaya/driver/handler
Please enter a valid phone number.
Name of your dog's vet or vet Clinic*
Phone number of your dog's vet*
Please enter a valid phone number.
Please Upload Photos of Your Dog's Vaccination Records. If you experience technical difficulties in uploading these photos, please present the original vaccination records to our Frontdesk Staff who will review the records and take photocopies for our records.

Anti-rabies and 5 or 6-in-1 vaccinations must be up to date within the last year. These must have been administered by a licensed veterinarian. Deworming must be up to date within the last 3 months. Kennel cough and anti-flea/tick/heartworm prophylaxis must be up to date within the period prescribed by the treatment given. We reserve the right to refuse to accept a dog for Playcare or the Puppy Circle on account of the incompleteness of its vaccinations and prophylactic treatments, or the incompleteness of its vaccination records, or if the dog appears ill or is ailing, has ticks or fleas, has wounds, or has just been released from an operation or confinement at veterinary clinic.
Cover page of your dog's vaccination records.

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Page of your dog's vaccination records showing anti-rabies vaccinations.

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Page of your dog's vaccination records showing core vaccinations.

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MEDICATION. Please list the medications your dog is taking and the times and dosage of each. If your dog is on any medication, please make sure they are with your dog when you check your dog in. We reserve the right to refuse to accept a dog on account of the need to medicate the dog. If there are no medications or supplements, please state "None."
MEDICAL CONDITIONS. Please list all your dog's medical conditions, the symptoms, and the treatment for each. We reserve the right to refuse to accept a dog on account of its medical condition. If there are no medical conditions, please state "None."
BEHAVIOR ISSUES. Please list any behavior issues that your dog exhibits, particularly any that may be viewed as aggressive or predatory. We reserve the right to refuse to accept a dog on account of its behavior issues. If there are no behavior issues, please state "None."
Which parts of your dog's body, if any, are sensitive to touch?
Will your dog allow others to hold it by the collar?*

YesNo
Can we give your dog some of the food treats we have on hand?*

YesNoYou may give my dogs only the treats I have brought and provided for the day.
Has your dog ever bitten anyone or another animal?*

YesNo
If the answer to the above question is "Yes," please indicate who was/were bitten, when, what type of wound resulted, and was there blood as a result of the bite. If the answer to the above question is "No," please indicate NA.
Which 3 adjectives best describes your dog’s personality?

AnxiousBarky or whineyBossyCalmGoofyHigh DriveHumps other dogsIrritableNeedyPlayfulProtective of food or toysRowdyShy or Worried
Is there anything else you would like us to know about your dog?
By submitting this filled out online form you acknowledge and represent that the information you have provided is true and correct, to the best of your personal knowledge; you also reiterate your agreement to the terms of the

We require the foregoing information to understand your needs and provide you with better service. We may use the information to improve our products and services; we may periodically send promotional email about new products, special offers, or other information which we think you may find interesting using the email address which you have provided. From time to time, we may also use your information to contact you for market research purposes. We may also contact you by email, phone, or mail should the need arise to ensure you have full information about the services you purchased.
Signature*

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