Daycare Application - Village Sentry Pet Care

Daycare Application - Village Sentry Pet Care
Village Sentry Pet Care
Doggie Daycare Agreement & Application
Our goal here at Village Sentry Pet Care is to achieve an ideal environment for your dog(s) to safely play and
socialize. In order to successfully obtain our goal we must carefully evaluate and screen all dog(s) as they try to join
our daycare family. This screening process is our way to ensure a comfortable and happy place for your dog(s) to
exercise and make friends during the week.
Please mail completed application to P.O. Box 1259 Hollis, NH 03049
OWNER INFORMATION
Name: ____________ Date: ________
Address: ______________ City: ________ State: ____ Zip: _____
Home Phone: _________ Cell Phone: _________ Day Phone: ________
Email: _________________
PET INFORMATION
Name: ___________________ Breed: _________ Age: _________
Sex: Male / Female / Neutered / Spayed
Date Spayed / Neutered: ___________
Adoption date (if adopted): ______ Primary Veterinary Clinic: _____________
Veterinary Clinic phone number: __________
EMERGENCY CONTACT
Name: ____________ Date: ________
Address: ______________ City: ________ State: ____ Zip: _____
Home Phone: _________ Cell Phone: _________ Day Phone: ________
ADDITIONAL PERSONS AUTHORIZED TO PICK UP AND/OR DROP OFF
Name: ____________ Date: ________
Address: ______________ City: ________ State: ____ Zip: _____
Home Phone: _________ Cell Phone: _________ Day Phone: ________
Village Sentry Pet Care, LLC
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I understand that my pet (s) will be isolated and suspended from doggie daycare if he/she shows
signs of illness such as; coughing, sneezing, vomiting or diarrhea. I will not be allowed to attend
daycare until they have been well for 3 to 7 days depending on the case or I will provide proof
from a veterinarian that they can participate in boarding or daycare again. I understand that I
may be required to show proof of the negative fecal result.
I certify that my pet(s) has/have not shown aggressive behavior towards any person or any other
animal(s). I further certify that my pet(s) has/have not bitten any person or any other animal(s).
I understand that my dog will be isolated or suspended from daycare if she/he shows any
aggression or threatening behavior toward any person or any other dog. I understand that I am
solely responsible for the harm caused by my dog while my dog is attending.
I understand that my dog(s) can be permanently excused from our doggie daycare for any poor
behavior that includes; aggression of any kind, continual barking, fence fighting, excessive
mounting of other dogs or disruptive behavior.
I understand and agree that when dogs interact in a daycare environment they sometimes can
receive minor cuts and scratches. Any that developed with my dog will be treated as deemed best
by the staff here at Village Sentry Pet Care at our sole discretion, if I am unable to be contacted.
I assume full financial responsibility for any and all of the expenses involved.
I certify that I have read the policies of Village Sentry Pet Care and I understand the conditions
of this agreement.
Owner signature:
X__________________
Date:
X ________________
Health
How does your dog react to getting a nail trim? ___________________________
Does your dog have any allergies? Yes / No
If yes, please list _______________________________________
Is your dog currently on any medication? Yes / No
If yes, please list
_________________________________________________
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Do you use any flea/tick preventative on your dog? Yes / No
If yes, which kind _______________________________________
History
Was your dog adopted / rescued? Yes / No
If yes, do you know any prior history about your dogs’ background?
_________________________________________________
_________________________________________________
How long have you owned your dog? _______
Does your dog have any training history?
Group class: Basic / Advanced
Agility
Obedience titles / awards
Puppy kindergarten
Trained yourself
Private training
Other: _____________________________________________
Has your dog ever been to an off leash dog park? Yes / No
Has your dog ever been to a different doggy daycare facility in the past? Yes / No
If yes, please explain the reason for leaving that facility:
_________________________________________________
_________________________________________________
Is your dog around children ever? Yes / No
If yes, how does he/she like being around the children?
_________________________________________________
Are there any other animals in your home? Yes / No
If yes, please list all other animals:
_________________________________________________
_________________________________________________
Is your dog crated while you’re out of the house? Yes / No
Is your dog allowed to roam free in your home? Supervised / Unsupervised
Is your dog allowed to roam free in a fenced yard? Supervised / Unsupervised
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Behavior
Is your dog afraid of any noises or occurrences? Yes / No
If yes, which noises and/or occurrences?
_________________________________________________
Any specific phobias that your dog may have that we should be made aware of?
_________________________________________________
_________________________________________________
How does your dog act towards strangers in your home?
_________________________________________________
_________________________________________________
How does your dog react to puppies?
_________________________________________________
_________________________________________________
Are there any breeds / types of dogs that your dog particularly dislikes / fears? Yes / No
If yes, which breeds/types? __________________________________
Has your dog ever growled/snarled at any persons? Yes / No
If yes, under what circumstances?
_________________________________________________
_________________________________________________
Has your dog ever bitten another dog? Yes / No
If yes, under what circumstances?
_________________________________________________
_________________________________________________
Has your dog ever been bitten / attacked by another dog? Yes / No
If yes, under what circumstances?
_________________________________________________
_________________________________________________
Has your dog ever participated in a dog fight of any sorts? Yes / No
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If yes, under what circumstances?
_________________________________________________
_________________________________________________
Has your dog ever climbed / jumped over a fence? Yes / No
Does your dog ever show protective behavior around any toys, treats or food? Yes / No
Does your dog like to play with toys? Yes / No
If yes, which toys does your dog particularly care for? ___________________
Does your dog know any commands? Yes / No
If yes, which commands? ___________________________________
Choose words that best describe your dogs’ personality
Mellow
High energy
High strung
Anxious
Calm
Dominant
Alert
Jealous
Shy
Unruly
Happy
Well - behaved
Submissive
Timid
Possessive
Immature
Playful
Aggressive
Fearful
Sweet
Choose words that best describe your dogs’ behavior
Dog aggressive
Growls at strangers
Fence fights
Jumps on people
Can’t grab collar
Separation anxiety
Eats rocks
Mouthy / bites
Mounts excessively
Eats poop
Jumps fences
Noise phobias
Destroys furniture / toys
Barks excessively
Escapes
HOW OFTEN WILL YOU BE USING DAYCARE
M: ___ T: ___ W: ___ TH: ___ FRI: ___ ALL WEEK: ___ BI-WEEKLY: ___
OTHER: ______________________________________________
I certify that I have read and filled out this questionnaire about my dog, ____________,
to the best of my knowledge and I understand the conditions of this agreement.
Signature: __________________
Village Sentry Pet Care, LLC
Date: _______________
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