Off-Leash Play Application

Off-Leash Play Application

Dog Daycare Registration
Owner's Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *
Phone Number *

- Area Code Phone Number
How did you hear about us? *
Internet Search, Advertisement, Friend, etc.

Emergency Contact Information

In the event that we are unable to reach you during an emergency, we will attempt to contact the individual listed below.
Name *

First Name Last Name
Phone Number *

- Area Code Phone Number
Who besides yourself is authorized to pick up your dog(s)?
Name

First Name Last Name
Phone Number

- Area Code Phone Number
Name

First Name Last Name
Phone Number

- Area Code Phone Number

CANINE INFORMATION

Please submit one application for each dog who you would like to have in off-leash play
Dog's Name: *
Veterinarian Office *
Breed *
Breed or Dominant Breed(S)
Colors/Markings
Gender *

Male Female
Neutered Spayed
At what age?
Birthday (or day celebrated): *
How long have you owned him/her?
What knowledge do you have of your dog's past history?

Health History
Please describe your dog's flea/tick control and prevention program: *
Does your dog have any allergies? If yes, please explain.
Does your dog have any physical disabilities? If yes, please explain disability and cause.
If yes to above question, what restrictions need to be placed on your dog's activities or movements?

No jumping No running No hard play Other option
Does your dog have any medical conditions? If yes, please explain.
If medication is used to control the condition, will medication need to be administered at daycare? If yes, please include instructions
How does your dog react to having his/her nails clipped?
Does your dog have any sensitive areas on his/her body? Where?
How frequently is your dog walked outside? How long are your walks?
Select the option that best represents your dog's overall exercise routine:

Couch Potato: spends day sleeping, occasional walks and/or playtime with humans/dogs Mild Exerciser: Short daily walks and/or regular playtime with humans/dogs Moderate Exerciser: Long or multiple walks daily and/or regular playtime with humans/dogs Athlete: Regular jogs/runs and/or regular participation in a dog sport activity such as agility, fly-ball, Frisbee, etc.
Please upload a copy of your dog's current vaccination records.

Browse Files

Cancel of
In order to provide a safe and healthy environment for all our visitors, we ask that if there is a change in your dog's health that you notify us immediately. Also, please submit updated vaccination records after your dog's yearly physical. Your veterinarian is welcome to fax them to us directly 518-562-0550.

I, __________________, hereby certify that my dog(s): __________________ is/are in good health and has/have not been ill with any communicable condition in the last 14 days. I further certify that my dog(s) has/have not harmed or shown aggressive or threatening behavior towards any person or any other dog. I have read and understand the following:

1. I understand that I am solely responsible for any harm caused by my dog(s) while my dog(s) is/are attending Canine Adventure, LLC.

2. I further understand and agree that in admitting my dog(s) to Canine Adventure, LLC, staff have relied on my representation that my dog(s) is/are in good health and has/have not harmed or shown aggressive or threatening behavior towards any person or any other dog.

3. I further understand and agree that Canine Adventure, LLC and their staff, will not be liable for any problems that develop, provided reasonable care and precautions are followed, and I hereby release them of any liability of any kind whatsoever arising from my dog’s/dogs’ attendance and participation at Canine Adventure, LLC.

4. I further understand and agree that dogs can sometimes receive minor cuts and scratches at daycare and any problems that develop with my dog(s) will be treated as deemed best by the staff at Canine Adventure, LLC, at their sole discretion, and that I assume full financial responsibility for any and all expenses involved.

5. I give permission to Canine Adventure, LLC to use any photographic likenesses of my dog(s) in all forms of media for advertising, promotion, and any other lawful purposes.

6. I certify that I have read and understand the policies of Canine Adventure, LLC as set forth in the preceding paragraphs - my name, date, and dog's name below indicate this certification and that I have read and understand the conditions, and statements of this agreement, including the following:

DAYS AND HOURS: Monday through Friday from 6:30 a.m. to 6:30 p.m. There is a $5.00 per 10 minute charge for any dog left after 6:30 p.m. If your dog(s) is/are not picked up by 6:45 p.m. they will spend the night and the overnight rate will apply.

Consent for Veterinary Treatment: In the event that my canine needs medical treatment and I am not able to be reached Canine Adventure, LLC and their staff has permission to approve necessary treatment on my behalf.

No Show Fee: I understand that in the event that I do not give Canine Adventure, LLC 24 hours notice that my dog(s) will not be in attendance they will charge my account the current daycare rate which I will be responsible for.
Date *

- Month - Day Year
Date
Name *

First Name Last Name
Dog's Name *
Signature *

Clear
Thank you for the time you spent completing the application form. We look forward to meeting you and your dog on their evaluation day. If your dog is not currently scheduled for an evaluation, we will contact you soon to set up an appointment. In the meantime, please contact us if you have any additional questions at 518-562-0552.
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Off-Leash Play Application

Emergency Contact Information

CANINE INFORMATION

Health History

Canine Behavior