Lou's Dog Grooming - Daycare Registration
Private and Confidential. This form is stored in a digital format and will be used as a record for you and your dog as part of the licensing regulations of Epsom and Ewell council.
Please select the days you require daycare for your dog
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Monday
Tuesday
Wednesday
Thursday
Friday
What time would you like to drop your dog at daycare?
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Drop off is available from 7.30am Minutes
AM
PM
AM/PM Option
What time would you like to pick your dog up from daycare?
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Latest collection available is 5.30pm Minutes
AM
PM
AM/PM Option
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Emergency contact and phone number if you are not contactable
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Back
Next
Tell us about your dog(s)
Dogs Name
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Dogs Breed
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Dogs Date Of Birth
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Microchip Number
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What sex is your dog?
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Male
Female
Is your dog neutered/spayed?
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Yes
No
Please note that we are unable to accept bitches in season. Please confirm that you have read and understand this.
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I understand
An up-to-date veterinary vaccination form must be provided to show dogs have current vaccination against, canine parvovirus virus, canine distemper, infectious canine hepatitis (adenovirus) leptospirosis, and other relevant diseases. These must be completed at least 2 weeks before accepting into daycare. We are unable to accept a titre test as an alternative to a vaccination.
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Please provide the names of your dogs flea and worm treatment
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Date of last worming treatment
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Month
-
Day
Year
Date
Date of last flea treatment
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-
Month
-
Day
Year
Date
Vet's details - Please provide their name, address and contact details
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Please provide your dogs insurance policy number and details
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Specific information on your dog
Does your dog have any allergies/intolerances?
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Yes
No
If yes, please give further details
Please provide feeding instructions for your dog including the name of the food, amount and feeding times. Please provide portioned food where possible.
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Is your dog allowed treats provided by the salon as rewards?
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Yes
No, only treats provided by me
Does your dog have any medical conditions?
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Yes
No
If yes, please provide further details
Does medicine need to be administered?
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Yes
No
If yes, please provide further details
Please provide dosage, instructions for administration and the name of the medication
More about your dog
Please help us understand more about your dog's character
Do they like cuddles?
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Yes
No
Sometimes
Are they nervous of loud noises?
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Yes
No
Sometimes
Are they possessive with food?
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Yes
No
Sometimes
Are they happy to share toys with other dogs?
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Yes
No
Sometimes
Are they aggressive with people?
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Yes
No
Sometimes
Are they aggressive with other dogs?
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Yes
No
Sometimes
Please list any commands that your dog is familiar with
E.g. sit, stay, wait, come etc
Is there anything else we should know about your dog?
Consents
I agree that in the case of suspected injury or illness to my dog a Veterinary Surgeon (Vet) may be contacted my dog may be examined, and investigations performed if required (e.g. blood tests, x-rays) and an appropriate course of action will be taken on the advice of the Vet. I understand that where possible any treatments will be undertaken by the dog’s ordinary vet, but maybe at the nominated vet of Lou's Dog Grooming, where that’s not possible. I agree to Lou's Dog Grooming administering any prescribed treatment the Vet considers advisable. I understand that the veterinary consultation, tests and treatment will be at my own expense. I also give consent for euthanasia should this be recommended on humane grounds by the Vet caring for my dog. I understand that every effort will be made to get in touch with me or my local proxy to discuss an appropriate course of action for my dog and Lou's Dog Grooming will endeavour to keep you (or emergency contact) updated throughout the process. I agree that if my dog has fleas or worms then Lou's Dog Grooming will take the dog to the Vet to arrange an appropriate treatment and charge the vets bill to me
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I consent
I consent to my dog(s) being fed with (at the same time and place) dogs from other households
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I consent
I consent to my dog mixing with dogs from other households whilst in daycare at Lou's Dog Grooming
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I consent
I consent for my dog(s) to be walked outside of the daycare environment
I consent
I consent for my dog to be let off a lead outside of the daycare environment
I consent
I consent to my dog(s) being walked within a group of dogs from other households (never exceeds 6 dogs)
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I consent
I consent to my dog being kept in a crate as part of its normal routine. (Only tick if your dog normally uses/sleeps in a crate)
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I consent
N/A
I consent to my dogs being kept together. (Only for clients with more than one dog)
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Yes
N/A
I consent to my dog(s) being posted on social media
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I consent
No
Please note, we are unable to house puppies in a separate environment to mature dogs. Please confirm that you consent to your dog mixing with older dogs if applicable.
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I consent
N/A
Do you understand and consent that your dog will participate in the following programme? 7.30am - 10.30am - Drop-Offs, breakfast, toilet breaks and play 10.30am - 11.30am - Morning walk. This will be 45 minutes to an hour long. Dogs will be walked in their daycare group in the local area. 11.30am- 1.30pm - Winding down after the morning walk. Dogs will be encouraged to rest and get cosy in their own areas or comfy sofa. Dogs who require a lunchtime meal will be fed in a private pen. 1.30pm - 2.30pm - Toilet breaks, socialisation and indoor enrichment activities such as snuffle balls and mats, lickimats and stimulation games. 2.30pm - 3.30pm - Afternoon walk. This will be 45 minutes to an hour long. Dogs will be walked in their daycare group in the local area. 3.30pm - 4.30pm - Winding down and grooming. Staff will ensure dogs are ready to return home and in good condition. Grooming packages are available for owners who like their dog to return squeaky clean. 4.30pm - 5.30pm - Dogs are generally tired at this point and will have a choice of activities and rest. Toileting opportunities are always offered and owners will start collecting their dogs.
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I understand and agree
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