Canine Information
Name:
*
Date of Birth:
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Month
-
Day
Year
Date
Weight:
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Size:
*
Small
Medium
Large
Gender:
*
Male
Female
Spayed/Castrated/Neutered/Entire:
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Spayed
Castrated/Neutered
Entire
Breed
Microchip Number:
Date of last Vaccinations:
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Month
-
Day
Year
Date
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
Date of last Kennel Cough:
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Month
-
Day
Year
Date
Country of birth?
Homed as a puppy?
Yes
No
Rescue?
Yes
No
Human Information:
Name:
Full address:
Mobile/Home Number:
Email Address:
Emergency Contact Information
Name:
*
Full address:
*
Mobile/Home Number:
Email Address:
Vet Contact Information
Name of Vet/ Surgery:
Full Address:
Contact Number.:
Email address if available:
Veterinary Release Form
The welfare of your dog is paramount. We will always contact the vet for any concerns, so that they can give necessary advice. We also record this information. In the case that your dog may need veterinary support /treatment or hospitalization whilst boarding with HILLCOTE PETS, we ask that you agree and sign the following form. To the Businesses Registered Vet/Dog’s own Vets/Animal Hospital: HILLCOTE PETS is a Licenced Home Dog Boarding business contracted to look after my pet(s) whilst I am away. They have my permission to place them in your care in case of an emergency. Kayleigh, or a member of her team, will attempt to contact me as soon as medical care is deemed necessary. However, in the event I cannot be reached immediately, I authorize you to treat my pet(s) and will be responsible for payment of any fees as stated below.
Veterinary Surgery:
*
Address:
*
Phone:
*
If above named veterinarian surgery is not available, I give my permission for Kayleigh Rivett at HILLCOTE PETS to take my dog(s) to her business registered vet or to the nearest animal hospital or emergency clinic. I give permission for Kayleigh Rivett at HILLCOTE PETS to approve treatment up to this amount in GBP:
*
INSURANCE DETAILS & POLICY No:
*
I understand that HILLCOTE PETS assumes no responsibility for the loss of any pet and is released from all liability related to treatment. I also agree to be responsible for all special services assessed by HILLCOTE PETS for emergency transportation, care or supervision and will pay fees when I return to England. Injury and Indemnification. If dog owner’s dog(s) accidentally dies, becomes ill or injured, the dog owner waives and releases HILLCOTE PETS from any claim arising from such an incident. In the event of the dog’s death the owner will be contacted imminently, and the dog removed to the local vets for storage until the owners return. Please write "I understand" or "I don't understand" below.
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My pet(s) has/have the following health issues/ past injuries and take the following medications:
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This consent for treatment has no expiration date and grants permission for future veterinary care without the need for additional authorization each time my business cares for one or more of my dogs unless otherwise noted. WE WILL PROVIDE 2 COPIES OF THIS VETERINARY RELASE FORM (PAGE 2) (One for your vet to have on file and one for my business records). Please indicate you agree by ticking the box below:
*
Yes
No
KENNEL COUGH
As per our terms and conditions all dogs must have the Kennel Cough vaccination 2 weeks+ prior to boarding. In some cases where this is not possible the owner must sign the disclaimer below. I take full responsibility if my dog contracts the Kennel Cough virus during boarding/going out for walks & therefore, I will not make any claim on HILLCOTE PETS business insurance nor will I hold HILLCOTE PETS responsible for any: illness to my dog Death of my dog. I will however take full responsibility for my dog infecting others, who are vaccinated, & pay for any costs incurred by any dog that contracts the virus due to my dog not being vaccinated. Any costs incurred (treatment, medication etc) including mileage (charged at £0.50p/mile) must be paid to HILLCOTE PETS within 5 days of any medical intervention by a Veterinarian. I confirm that I understand the above:
I confirm that I understand the above:
Yes
No
CONTINGENCY PLANNING:
Worst Case scenario: If your dog is injured or dies in our care, under our license regulations we must take your dog to be stored at their vets, until you return. Do you wish to know straight away or when you get back?
Away
Back
If anything was to happen to you whilst you were away (road accident, hospitalisation, death), excepting your secondary contact, who would you want me to place your dog with if not your emergency contact?
DOG PROFILE:
Does your dog get along well with others of the same species?
Yes
No
Is your dog frightened by any noises?
Yes
No
Does your dog get on with puppies/ younger pets of same species?
Yes
No
Does your dog bark a lot?
Yes
No
Does your dog share well?
Yes
No
Does your dog show any destructive behaviours, when you are not at home? Does your dog suffer from separation anxiety?
Yes
No
Does your dog have obedience training?
Yes
No
Is your dog house trained/toilet trained? Is your dog house trained/toilet trained?
Yes
No
Do they pull on their lead? If so, how do you handle this? Is your dog reactive or aggressive on a lead? If so, how do you handle this? Can your dog be walked off lead in safe areas away from roads? Does your dog recall with distractions (e.g. other dogs?) Do you use recall tools?
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Does your dog mind having their coats or feet checked for foreign objects etc, and washed if necessary (rolled in fox poo)?
Yes
No
Does your dog destroy toys?
Yes
No
Has your dog bitten a human before?
Yes
No
Has your dog been attacked by another dog before?
Yes
No
What commands does your dog know/ use?
Does your dog travel well in a car? If so where do they sit? All dogs have a seat belt attached to their harnesses in our vehicle. Please provide a harness.
Does your dog use a crate or pen? and if so how long is your dog in a crate for? Is this where your dog sleep and if not, where do they sleep?
When you go out and leave your dog at home, where do you leave them (room, crate, bed?)? Do you give them anything to keep them occupied and if so what? Where does your dog normally sleep?
ABOUT YOUR DOG & YOU
Is your dog food and/or toy orientated? (what treats or food/toy do they enjoy?) (Are they allergic to anything?)
Are they obsessed with a particular toy? And are you aware of any resource guarding issues?
When you are at home, what games do you play with your dog? What enrichment activities to you do, and, or what tools do you use? How does your dog react to them? Do they show interest? What other activities do you do with your dog at home?
Has your veterinarian given you any advice regarding health & well-being for your dog? If so what?
Does your dog have any physical, mental or medical issues, that we need to be aware of? If so what?
OTHER HUMANS
How sociable is your dog/s with humans (including children)? Do they interact with each other appropriately? Are there any concerns?
*
Is your dog regularly groomed by another human (not family related)? How do they react? Any issues/concerns/behaviours?
*
Has your dog ever displayed reactive, fearful or nervous tendencies? (no matter how small)
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How does your dog get on with other dogs? At home, out on a walk, in day boarding etc? Do they play ok together? Have you encountered any problems? Received feedback from other services/professionals?
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OWNERS PERMISSIONS - EXERCISING OFF LEAD
OFF LEAD/LONG LINE LEAD PERMISSION REQUIRED We always keep boarding dogs on-lead unless you agree to give us permission to let them off lead. We only let the dogs off after a period of getting to know them, and areas away from the main road. We can use long lines as an extra precaution. Please read and sign the form below:
I give permission for HILLCOTE PETS to walk my dog off lead in enclosed areas and areas away from roads, or on a long line as an alternative. (delete where necessary) By permitting this, I will not hold HILLCOTE PETS responsible for any: • Loss of my dog, • Injury to my dog, • Injury to another animal by my dog, • Injury to a member of the public, or • Death of my dog nor will I make a claim on HILLCOTE PETS insurance company, unless the company is found to be negligent.
*
Yes I give permission
No I do not give permission
EXTRA OWNER PERMISSIONS
As Dog Walkers we are required to seek owners’ permissions for certain activities, such as your dog: exercising, in the same designated area, with other dogs, being walked at the same times as yours, being groomed, being transported.
Are you the owner ok with your dog/s WALKING AT THE SAME TIME WITH OTHER DOGS FROM DIFFERENT HOMES ? We assess every dog who becomes a customer and we carefully match dogs who get on together and are able to share walks without any behaviour issues.
*
Yes
No
FOR DOGS FROM SAME HOUSEHOLD ONLY (13.2) Dogs from the same household can be kept together. However, there may be times where it is necessary to separate them. Are you okay with this? (Cross out boxes if not applicable)
Yes
No
EXERCISING & PLAYING & RECEIVING MENTAL STIMULATION WITH OTHER DOGS (7.1) Your dog will have opportunities to exercise, through walks, play & socialisation, entertainment, environmental enrichment.
*
Yes
No
ENRICHMENT PROGRAMME. (7.0) We provide active and effective environmental enrichment to all dogs, this supports physical and cognitive stimulation. Are you as the owner okay with your dog’s participating in this? If your dog has a medical condition, (where the vet has advised they cannot go for a walk) or the weather is deemed as unsafe to go out for a walk, we will use enrichment as an alternative too.
*
Yes
No
BEING TRANSPORTED WITH OTHER DOGS IN MY VEHICLE (5.6) Your dog will travel either in the boot or back seat of the car. And clipped in as per Rule 57 of the Highway Code. Where possible they must have a harness.
*
Yes
No
WALKING & EXERCISING OUTSIDE OF THE HOUSE WITH OTHER DOGS (7.2) Your dog will only be one of up to 6 dogs to be walked at any one time. (as per Animal Welfare Regulations 2018 & as per my insurance though I generally walk no more than 4). Each dog will be assessed to check compatibility to walk/exercise together.
*
Yes
No
BEEN CHECKED OVER & DAILY GROOMED (5.3) (After your dog’s walk it will be beneficial for your dog to have their body, paws, eyes, ears, teeth. gums etc checked for foreign objects (grass seeds, other vegetation, parasites etc). We will also check for matting and if necessary remove it, as this can cause your dog unnecessary pain. Are you okay/or not okay with us carrying out this task. Please, provide their own grooming equipment.
*
Yes
No
HILLCOTE PETS will monitor your dog’s behaviour during a body check and will cease if we feel that the dog is unhappy or uncomfortable in any way).
DOGS BEING LEFT WITH MY EMERGENCY CONTACT PERSON (5.9) In the case that we need to take another dog to the vet for an emergency for a short period of time, are you okay with us leaving your dog in the care of another insured person within Hillcote Pets? Your dog may be separated from others at this time, to mitigate any issues.
*
Yes
No
USING A CRATE. If your dog/puppy uses a crate, are you okay with us using one when dropping your dog back to its home? (Regulations state that the door must be kept open. However, if you wish the door to be closed to ensure that they are safe, and away from other dogs during resting periods, during day or night, we need the owners signed permission) (13.5) We will only use a crate if your dog is habituated to using one at home. Your dog can not be confined in a crate for longer than three hours in any 24 hour period as per DEFRA’s (2018) regulations.
*
Yes
No
By selecting Y or N, to the specific activities & signing below, I, the owner named on this form, am giving consent to HILLCOTE PETS to act as my dog’s guardian whilst my dog is in their care, and allowing my dog to participate with activities with other dogs at their home and out on a walk. I therefore will not, nor cannot hold HILLCOTE PETS responsible for any: • injury to my dog, • injury to another animal by my dog, • injury to a member of HILLCOTE PETS or • death of my dog nor will I make a claim on HILLCOTE PETS business insurance if any issues occur, unless HILLCOTE PETS is found to be negligent.
*
Yes
No
OWNER’s RELEASE:
Please note some photos /videos may be used on our Facebook page/Instagram/social media/website: HILLCOTE PETS will post these after their visit. Are you as an owner okay with this?
*
Yes
No
Please let us know the preferred ways to keep you up to date with your dog’s stay with us, including videos and photos: WhatsApp/Facebook/Messenger/Email. I understand that by signing this dog day care boarding form, I am are agreeing to, and are contractually bound by our terms and conditions. I agree that the information recorded on this document during our meet and greet trial assessment is accurate. I hereby confirm that I am the owner of the named pet written at the beginning of this dog boarding form, and I authorise Kayleigh Rivett at HILLCOTE PETS to act as guardian during my absence and agree for her to make any decisions regarding my dog’s health providing it is acting in the best interest of my dog and is on the advice of the registered veterinarian with whom my business is registered with.
*
Yes
No
GDPR
Please note that HILLCOTE PETS is required by law to keep records/a register of your dog & relevant details for a minimum of three years for Inspection by the local council (East Hampshire District Council). Information/Guidelines contained in the dog boarding, vet release & permissions document complies with the DEFRA Animal Welfare Regulations (2018).PLEASE NOTE: ALL FORMS (DOG BOARDING FORM, VET RELEASE, TERMS AND CONDITIONS & PRIVACY NOTICE.) MUST BE FILLED IN BEFORE YOU ARRIVE AT CONSULTATION. WE WILL GO THROUGH THEM WHEN YOU ARRIVE. ALL DOCUMENTS INCLUDING THOSE STATED ABOVE, WILL NEED TO BE SIGNED PRIOR TO OUR MEET AND GREET TRIAL ASSESSMENT.
MEET & GREET + TRIAL ASSESMENT
OUR MEET & GREET TRIAL ASSESSMENT MAY TAKE UP TO 1 hour, this is so we can : Observe your dog around ours and others, assess how they cope in different environments with new dogs & humans. Fill in any other necessary forms etc. and so you can meet the HILLCOTE FAMILY and ask any questions. We hope you will go away feeling more relaxed about your care for your dog, if you have never used this kind of service before. In the case you do not feel that this is the right place for your dog, or our assessment demonstrates that your dog is not suited, we will be happy to recommend others that may be more suitable.*THE WORD ‘DOG’ REFERS TO A DOG OR PUPPIES REGARDLESS OF AGE*
CONSULTATIONS
Before we consider a dog for any of our services, a meet & greet trial assessment in form of a walk must be carried out in advance. This is to check compatibility with other dogs as well as your dogs behavior whilst out on a walk. During the consultation we will discuss: Medical/Vaccinations, History, Behaviours, Exercise, Routines at Home, and you requirements. Please bring your dog’s Vaccination card, proof from veterinarian of any medical diagnosis or medicine & insurance details with you. If your dog was born abroad, we will need to see their passport too. It is, your responsibility to provide comprehensive details about your dog, and to be completely honest about any traits, vices or behavioural problems, both positive & negative (however small). We rely on this information to be able to manage any issues and provide a good experience and quality of service for your dog. Any misinformation may jeopardise your dog’s walk with us. We will note any behaviours that stand out to us in our trial assessments. We are not qualified trainers or behaviourists; however, we will do our best to manage any situation or issue that arises and will source guidance from other professionals if necessary. We may need to contact you if your dog exhibits any behaviours not previously disclosed.
Fees & Information
HILLCOTE PETS recognises that each dog and their owners’ needs are unique. The standard rates can be found on the HILLCOTE PETS website https://www.hillcotepets.co.uk. Emergency / 2nd Contact Without an emergency/secondary contact we unfortunately cannot walk your dog Booking & Cancellation fees Please note that payment is taken upon booking and we require at least 1 day/ week to be booked in. This will be invoiced monthly in advance and we require 1 calendar months notice for walking cancellations. This is to ensure consistency for both our dogs and staff. Termination of Dog Walking If you fail to disclose any negative behavioural problems during the trial assessment meet & greet or 3 days prior to the intended walk, should your dog show any sustained aggressive tendencies, bites other dogs or animals, or humans, is continually uncontrollable, destructive or shows unreasonable behaviour, the Dog walking agreement will be terminated with immediate effect. You will be advised accordingly. You also agree to pay the cost of any injury/damage caused by your dog to other dogs, animals or humans. No refund will be given. HEALTH & WELFARE All dogs must have current annual booster vaccinations before walking with us, and puppies to have had their second course of vaccinations. (This is required for our business insurance and as part of the DEFRA (2018) regulations). All dogs where possible must have their kennel cough (KC) vaccination at least 2 weeks prior to their first walk. This is for the protection of your dog and any dogs they may encounter. We will accept titre testing if a vet certificate is provided. Your dog must have been appropriately treated for external & internal parasites with an appropriate product authorised by VMD and in accordance with veterinary advice before entry to home day care boarding. At consultation you are required to bring the vaccination booklet so we can keep a copy on record and evidence, if possible (i.e. container box) of the drops or tablets you have given your dog to prevent parasites. Further proof of vaccinations and treatments may be requested and must be presented prior to arrival via email or an alternative method agreed in advance. Failure to produce a copy of the vaccination record will jeopardise your booking. We do not take dogs that have been ill within the last 24 hours, nor a dog who has had an infectious disease within 21 days prior to the walk. Should anything happen to your dog whilst in our care you will be notified ASAP, and everything will be done in our power to manage the situation. HILLCOTE PETS are fully insured but noting that dogs can play roughly, if your dog is hurt i.e. cut paw, ripped claw, you will be notified, and if a vet visit is required you are expected to attend and make payment directly to the vets. We are with the dogs during the day so we are on hand to manage any situation. If death is a possibility during walking (due to illness/old age etc) please notify HILLCOTE PETS in writing and agree arrangements for care. Un-Spayed/Entire Dogs Entire male dogs: We accept entire male dogs based on the dog as an individual and its own individual behaviour. All known behaviours must be declared during the meet and greet trial assessment. if they excessively mark/dominate or are uncontrollably aggressive, the boarding contract will be terminated with immediate effect. No refund will be given. Please be aware all dog’s behaviour is different in a new environment and may not be the same as at your home. Unspayed female dogs: We do not walk un-spayed female dogs after they have had their first season. It is difficult to ascertain when any female dog is coming into season, and as we own, and walk entire males, we do not want to cause any unnecessary distress. However, if she comes into her first season whilst with us, we will contact you, and either you or your 2nd contact will need to come and collect her. This is to keep all dogs safe and prevent unwanted matings. Medication We can administer tablet & liquid medication orally, ear/eye drops and injections such as insulin. Nail Clipping Please ensure your dog has had its nails clipped & filed to remove rough/sharp edges, before walking with us, to avoid accidental injury to humans or other dogs. Veterinary Release & Instruction It is your responsibility to contact your veterinary practice prior to the booking to inform them that your dog will be walking with us. If your dog becomes ill or injured whilst with us, it will be necessary for us to contact your vets for advice or, if necessary, to take them in for a medical consultation. If this isn’t possible, we will take your dog to our registered vets. If you request, we will contact you (if possible) in the first instance, prior to contacting the vet. We request that you provide permission for us to approve necessary treatment; and you, as the owner will assume full responsibility and pay for any required treatment. You agree that HILLCOTE PETS is authorised to take your dog to our registered veterinary practice for treatment. We strongly suggest that you have an insurance policy in place. HILLCOTE PETS cannot be held responsible for any veterinary treatment that may result in loss, injury or death of your dog. Insurance All Dogs should be insured wherever possible by the owner & insurance details given. Dog Collars & ID Tags All dogs by law, must wear a collar & ID tag. We will provide your dog with one of our own collars & ID tags during their walk with us. Exercise & Enrichment ll dogs will be walked on a lead when they are out, unless you have indicated that they can be off lead at certain times. We will always leash your dogs near roads. A signed off-lead permission/disclaimer form will be required. We aim to walk dogs locally without the need to drive to locations. However, in case these are not appropriate for your dog we ask that owners supply a transport harness for their dogs, so they can be appropriately and safely restrained using a dog seat belt in our vehicles. If you cannot provide a halter and there is an unavoidable incident in our vehicles, you will forfeit any claim on our insurance. WHAT WE PROVIDE We will provide safety, security, mental stimulation, including simple command training, adventures, entertainment, physical exercise, enrichment, companionship, socialisation with other dogs and humans. They will be treated as part of the family. WHAT OWNERS PROVIDE Any necessary equipment i.e. dog training equipment, harnesses, & or transport harness, collars, leads etc, treats, grooming equipment, baby wipes. PAPERWORK (REQUIRED AS PER DEFRA (2018) REGALATIONS All clients must complete & sign all relevant paperwork, including our terms & conditions, consultation & behaviour evaluation form, which includes the veterinary release instruction form & off-lead permission, any permission requests, and a privacy notice form, and where required, a Dog Walking contract. By signing the consultation form/Dog Walking contract, and any other necessary forms that pertain to HILLCOTE PETS, you agree to accept, and are contractually bound by our terms & conditions. You also agree that the information recorded on the document before and during consultation is accurate. INSURANCE, QUALIFICATIONS & TRAINING HILLCOTE PETS: are licensed by East Hampshire District Council & have been awarded a 3 year license & 5 stars from 2024 LICENCE No: 37545 are insured for Public Liability up to £5,000,000 with Cliverton are Ofqual accredited Level 3 qualification in Professional Day Care & Boarding (IMDT) (including dog walks) awarded January 2022 Canine First Aid (awarded 27th February 2022) and has many years’ experience with canines including working in Kennels and has successfully raised dogs of different types from puppies. All staff are DBS Checked CONFIDENTIALITY POLICY. Client confidentiality will be maintained at all times. Your details will be kept private and will never be used for any purpose other than caring for your dog. Days of Business We are open all year and will inform our regular clients of any vacation dates in advance. Daily Restrictions (number of boarders & day care dogs) Our boarding licence dictates the numbers we can have in, on any given day which includes 8 spaces for day care. We operate on a first come (full payment made), first served basis. Should we have full capacity, we will recommend other licensed boarders. Our Terms & Conditions are at times reviewed & updated. We will ensure you receive an updated version & you will be required to sign a new copy when we next board your dog.
I agree to HILLCOTE PETS Terms & Conditions and I am aware that I am contractually bound by them.
*
Yes
No
PRIVACY NOTICE
You (owner), give your consent that your details, and any data relevant to my work, will be held on record by myself, Kayleigh Rivett of HILLCOTE PETS, and processed under the terms of the General Data Protection Act 2018. In general terms this means: I have lawful basis, which in this case is to fulfil my contract with you. My purpose is to look after your dog(s) as agreed in writing. This data may be shared with colleagues, or relevant agencies, i.e. Veterinary staff, Police, RSPCA or rescue centres, Council & Government Departments if requested. If needed this may include processing your data to my colleagues, who if outside the EU, I will have ensured have proper procedures in place. Records will be securely kept and will not be kept for any longer than deemed necessary. You have the right to ask for your records to be viewed, amended, or deleted and you have the right to withdraw consent. You also have the right to complain to the overseeing regulator, the ICO, (www.ico.org.uk) if you feel your data has not been handled correctly.
*
Yes
No
Signature
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