TopDog DayCare Daycare and Boarding Registration

Full Name *

First Name Last Name

Address *

Street Address

City	State / Province
Postal / Zip Code	Country

Cell Phone Number *

Area Code Phone Number

Home Phone Number

Area Code Phone Number

Work Phone Number

Area Code Phone Number

Best number to contact you at? *

Cell Home Work

E-mail *

Secondary Owner Name

First Name Last Name

Secondary Owner Cell Phone

Area Code Phone Number

Secondary Owner Home Phone

Area Code Phone Number

Secondary Owner Work Phone

Area Code Phone Number

Secondary Owner E-Mail

Emergency Contact *

First Name Last Name

Emergency Contact Cell *

Area Code Phone Number

Emergency Contact Home

Area Code Phone Number

Emergency Contact Work

Area Code Phone Number

Best number to reach emergency contact. *

Cell Home Work

Vet Clinic *

Vet Clinic Phone Number *

Area Code Phone Number

Vet Clinic Address *

Street Address

City	State / Province
Postal / Zip Code	Country

How did you hear about TopDog?

Dog1 Name *

Dog1 Breed

Sorry we cannot accommodate pit bulls or pit bull mixes. Call if you have any questions.

Dog 1 Birthday

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Sex *

Male Female

Spayed/Neutered *

Yes No

Monthly Flea/Tick *

Yes No

Monthly Heartworm *

Yes No

Known Allergies

Rabies Vaccination Expiration Date *

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Bordetella Vaccination Expiration Date *

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Parvo/Distemper Expiration Date *

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Canine Flu Expiration Date *

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Is your dog wary of strangers?

Yes No Unsure

Does your dog play with toys?

Yes No Unsure

Does your dog destroy toys, bedding ,etc?

Yes No Unsure

Has your dog had any formal obedience training?

Yes No Unsure

Would you be interested in having formal training while in daycare?

Yes No Unsure

How often has your dog interacted with other dogs?

In what capacity has your dog interacted with other dogs? (daycare, walks, park, etc)

How does your dog behave with other dogs?

Has your dog ever growled at, snapped at, or bitten anyone? *

Yes No Unsure

If yes what were the circumstances?

Does your dog have any record with a city government or animal control for having bitten another dog, or bitten a human, or for being "vicious"? *

Yes No Unsure

If yes what were the circumstances?

Is your dog a "rescue"

Yes No

Is there any background information you would like to share with us?

Is there anything else you'd like to tell us about your dog?

Service Agreement 
This DOG DAYCARE & BOARDING AGREEMENT ("Agreement”) is made by and between TopDog DayCare, LLC and the person signing below (hereinafter known as “Pet Owner”) I certify by signing here that all information entered above is current and correct. WHEREAS, TopDog DayCare wishes to provide dog daycare and/or boarding services and Pet Owner wishes to accept such service on the terms and under the conditions recited below; The Parties, intending to be legally bound, hereby agree as follows: 
1. Prices for Services are published detailed on our Website & Pricing Guide. Prices are subject to change. Payment for all services is required daily or as requested by TopDog DayCare. Cash, check, and credit card payments are accepted. If you are allowed to run a balance, payment for services received will be required in full upon demand by TopDog DayCare. 
2. TopDog DayCare reserves the right to not accept a dog into daycare or boarding for any reason. All rules of the center are subject to change at the sole discretion of TopDog DayCare.
3. TopDog DayCare agrees to provide a cageless, off-leash environment for your dog to exercise and socialize with other dogs and our staff. Inasmuch pet owner realizes that there are risks associated with participating in cage-free socialization. I understand that in the event of an emergency, TopDog DayCare will make every attempt to contact me. In the event that I cannot be reached, I authorize the following: In the event of illness or injury, I authorize TopDog DayCare to seek appropriate medical treatment for my pet. I understand that every effort will be made to take my pet to the vet clinic specified on the registration form if the situation permits however; TopDog DayCare has the authority to seek treatment at any veterinary clinic. Furthermore, I agree to reimburse TopDog DayCare within 14 days of incident for veterinary fees and all related costs including transportation. This release does not expire and will remain valid for all future TopDog DayCare services..
3.Pet Owner authorizes TopDog DayCare and its representatives to transport said dog and obtain medical treatment for the dog, in the event of an illness or accident. 
4. Pet Owner agrees to hold TopDog DayCare, its members, owners, directors, officers, agents, employees and lessor of the premises, harmless from any and all claims for loss or injury (including legal fees) which may be alleged to have been caused directly or indirectly to any person or thing by the act of the dog, and Pet Owner personally assumes all responsibility and liability for any such claim. Pet Owner further agrees to hold aforementioned parties harmless from any claim (including legal fees) for loss of the pet by disappearance, theft, death or otherwise, and from any claim or damage or injury to the dog whether such loss, disappearance, theft, damage or injury be caused or alleged to be caused by the negligence of TopDog DayCare or any of the parties aforementioned. Pet Owner assumes sole responsibility for and agrees to indemnify and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting wherefrom, or sustained by any person or persons, including Pet Owner, howsoever such injuries, death or damage to property may be caused, and whether or not the same may have been caused or alleged to have been caused by the negligence of the aforementioned parties or any of their employees, agents, trainers or any other persons 
5. Pet Owner certifies that he/she is the actual owner of the dog, or is the duly authorized agent of the actual owner whose name is entered above. 
6. Pet Owner represents that the pet is free of any infectious disease and is vaccinated for DHPP (Distemper, Hepatitis, Parainfluenza, Parvo), Bordatella, and Rabies. Pet Owner represents the pet is also free of contagious parasitic problems, whether internal or external (including fleas & ticks), and is free of any contagious skin disorder. 
7. Pet owner understands that even if your dog is vaccinated there is still always a chance that your dog may be exposed to or contract a communicable illness. At TopDog we are vigilant about making sure all of our clients dogs are vaccinated against bordetella, but although most cases of kennel cough are caused by bordetella, some are caused by other agents, including the bacteria bordetella bronchiseptica, canine adenovirus type 2, canine parainfluenza virus, canine respiratory coronavirus, and mycoplasmas, so the vaccine may not prevent your dog from catching the disease.
This is similar to the "flu shot" for people; each year a vaccine is developed based on which strain(s) are suspected to be most prevalent. Simply put, having the flu shot does not guarantee you won't get the flu and when your dog has a Bordetella vaccination it doesn't guaranteed he or she won't get kennel cough.
We will always refuse entry to dogs exhibiting symptoms of kennel cough, but unfortunately we cannot control what dogs bring in from the outside world and it is sometimes difficult to pick up any signs as dogs are most contagious right before showing symptoms. Dogs with kennel cough will often even have the same energy level and appetite.
8. Pet owner is aware that TopDog DayCare is a cageless daycare and is aware that there is inherent risk of illness and injury when dealing with animals. pet owner agrees to pay for any vet bills from any injuuries occuring at TopDog Daycare.
9. Pet owner agrees to allow TopDog Daycare access to dog's medical records.
10. This Agreement sets forth the entire agreement between the Parties with regard to the subject matter hereof. This agreement may be modified, superseded, or voided only upon the written and signed agreement of all the Parties.
11. Pet owner gives permission to use their dogs likeness, photos/video etc. in TopDog promotional materials online on social media or otherwise. 
12. Please call if you are running late. We will do our best to accommodate you. By signing this document you agree to late fees as follows:Monday-Friday: $10 at 7:16pm and again at 7:31pm. After 7:31 your dog will be placed in overnight boarding. With late fees and boarding fees accrued.Saturday: $10 at 5:16pm and again at 5:31pm. After 5:31 your dog will be placed in overnight boarding. With late fees and boarding fees accrued.
13. Pet Owner represents that the information in the attached Dog Daycare application and/or Boarding In-Take Form is true and that TopDog DayCare is reasonable to rely on the accuracy of said information.

By signing below I confirm I have read and understand the terms set forth above. I agree to abide by all the terms, conditions and statements of this agreement. *

Agree Disagree

Sign Below *

Clear

Print Name *

Date *

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Received Form and Contacted How?

Came in for in house assessment?

Contacted after first day assessment?

TopDog Daycare Daycare/Boarding Registration Form and Agreement