Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Additional Owner's Name
First Name
Last Name
Additional Owner's Phone Number
Emergency Contact
*
In the event we are unable to contact you when your dog is with us, who can we count on as an emergency contact. This should be someone who can make decisions on behalf of you for your dog.
First Name
Last Name
Emergency Contact Phone
*
(###)
###
####
Besides yourself, who else is authorized to drop off and/or pick up your dog? Please provide their names and relationships to you.
How did you hear of our daycare / boarding program?
*
Is your dog currently, or has your dog been a student in our training program? (Please note that due to demand, we are currently only accepting into our program dogs that are or have been part of our training program.)
*
Dog's name
*
Dog's breed
*
What is your dog's birthdate (approximate if unknown)
*
MM
DD
YYYY
Which of the following describes your dog? (Please note that we require all dogs in our group daycare to be spayed or neutered by the time they are 12 months old.)
*
How long have you had your dog?
*
Where did your dog come from?
*
Why are you interested in Daycare and/or Boarding at the Canine Connection? Please let us know the top three (3) benefits you are seeking from your dog’s participation in our dog daycare and/or boarding program.
*
Which veterinary office do you use? (If more than one, what is the primary office?)
*
If your dog's veterinary office was not listed above, please list here.
Which the following is your dog current on? (Please remember that you must ask your veterinarian to FAX or email us vaccination records before we can schedule your evaluation).
*
Is your dog on monthly flea control?
*
Is your dog on monthly heartworm preventative?
*
Does your dog have any allergies, dietary needs, and/or physical health conditions. If so, please describe.
Where does your dog sleep at night?
*
Where does your dog stay during the day?
*
What is your dog’s favorite activity?
*
My dog enjoys meeting new dogs when on leash
*
My dog enjoys meeting new dogs when off leash
*
My dog enjoys meeting new people
*
My dog can be fearful of new dogs he or she meets
*
My dog can be fearful of new people he or she meets
*
My dog goes to dog parks
*
My dog has been boarded away from home
*
Where has your dog previously boarded?
My dog has attended dog daycare somewhere else
*
Where has your dog previously attended dog daycare?
My dog spends time alone at home
*
My dog spends time resting in a crate
*
My dog is comfortable going to the veterinarian
*
My dog guards toys, other objects, food, and/or locations from other dogs (e.g. growls or snaps if another dog approaches when with food)
*
My dog guards toys, other objects, food, and/or locations from people (e.g. growls or snaps if a person approaches when with food)
*
Please describe the situations when your dog guards toys, other objects, food, and/or locations from other dogs or people.
My dog is sensitive to sounds (e.g. thunder, trains)
*
Please describe the sounds and noisy situations that frighten your dog.
My dog pees and/or poops in house
*
My dogs barks for attention, when frustrated, and/or excited
*
My dog ingests foreign objects (rocks, fabric, toys, etc.)
*
Please describe the items your dog ingests and if there are particular situations when your dog ingests things.
My dog jumps over or digs under fencing to get out of a yard
*
My dog is awesome 😎
*
Please let us know if there is anything else we should know about your dog.
I understand and agree that The Canine Connection LLC and its owner, employees, volunteers, and any other agents (hereafter referred to as “The Canine Connection”) will not be liable for any behavior or medical problems that develop with my dog provided reasonable care and precautions are followed. I hereby release The Canine Connection of any liability of any kind whatsoever arising from my dog’s attendance and participation at The Canine Connection’s daycare and/or overnight boarding program.
*
I understand that I am solely responsible for any harm to a person or property caused by my dog while my dog is attending daycare and/or overnight boarding at The Canine Connection or in using any other services provided by The Canine Connection.
*
I understand and agree in admitting my dog that The Canine Connection has relied on my representation that my dog is in good health and has not harmed or shown aggression or threatening behavior toward any person or any other dog.
*
I further understand that it is my responsibility to ensure that all required vaccinations are up-to date and to provide documentation of these to The Canine Connection so they have, on file, my dog’s most updated vaccination information.
*
If I fail to provide documentation of up-to-date vaccinations or if my dog’s vaccinations are found to be expired or otherwise incomplete, I understand that The Canine Connection has the right to refuse service until current proof is provided.
*
If my dog arrives at the facility with fleas and/or other parasites, The Canine Connection has the right to bathe and quarantine my dog until he or she is picked up and I take full responsibility for any expenses incurred to treat or house my dog including paying the full cost of daycare or boarding for that day.
*
I understand that the bordetella (canine/kennel cough vaccine) and the H3N8/ H3N2 canine influenza do not prevent all forms of canine/kennel cough or influenza that may be transmitted in a dog group environment and that it is possible that my dog may contract canine/kennel cough or “influenza” as a result of participating in daycare and/or boarding.
*
I understand that while all reasonable precautions are taken to ensure that all dogs at The Canine Connection are healthy, that contagious conditions such as kennel/canine cough, canine papilloma virus, and or H3N8/H3N2 canine ‘influenza” may be transmitted between dogs, that my dog may contract such conditions, that I will assume full financial responsibility for any and all expenses involved in treating any condition, and that I will be expected to remove my dog from daycare and/or boarding or other services until my veterinarian approves my dog’s return.
*
I understand that I am solely responsible for the medical treatment of any conditions or injuries that my dog receives while at or as a result of participating in the daycare and/or boarding program of The Canine Connection.
*
I understand there are currently no 24-hour emergency veterinary services in Chico and that after-hours and weekend emergency veterinary care is also limited. I further understand that the nearest emergency veterinarian, who may or may not be able to see my dog, is located in the greater Sacramento area or at UC Davis. Therefore, I understand that it is my responsibility to have updated personal contact and emergency contact information available to The Canine Connection at all times. I also understand that it is my responsibility to ensure my dog is healthy when admitted for boarding and that any special medical accommodations or needs are put in writing for and discussed with The Canine Connection prior to my dog being admitted for boarding. While The Canine Connection will do everything reasonable to ensure my dog receives veterinary if needed, my emergency contact person must be available to assist with transport and care of my dog, should that become necessary.
*
I understand that The Canine Connection shall not be held responsible for injury to or loss of my pet that may occur as a result of caring for my dog or transporting my dog for veterinary care.
*
If my dog becomes ill or is injured, I authorize The Canine Connection, at their discretion, to take my dog to my veterinarian. If my regular veterinary office is not available or convenient, I authorize the Canine Connection to take my dog to another veterinary office for treatment.
*
I understand that The Canine Connection shall not be held responsible for the results of the veterinary treatment.
*
I authorize The Canine Connection to have access to any and all medical records pertaining to my dog and to share those with any veterinarian who is treating my dog.
*
I give permission to The Canine Connection to approve initial veterinary treatment up to the cost of $1,000.
*
I will assume full responsibility upon my return for payment and/or reimbursement for any and all veterinary services and other expenses deemed best and/or necessary by the staff of The Canine Connection, in consultation with the veterinary staff involved with treating my dog.
*
For extended boarding stays at The Canine Connection, I will arrange in advance, with my veterinarian, to be billed or to pay directly for any required veterinary care.
*
I understand that The Canine Connection’s daycare and boarding program is a place where animals co-mingle and play in groups and that my dog may experience cuts, scratches, punctures, lacerations, abrasions and other sorts of injuries due to the nature of dog play.
*
I understand that my dog will be running and jumping and engaging in physical play with other dogs and staff and I understand that injuries may result to my dog because of this physical activity.
*
I understand that the pads on my dog’s paws may initially become sensitive, abraded, or otherwise bothered until my dog becomes used to running and playing on different surfaces.
*
I understand that while all dogs are evaluated for sociability and play style prior to beginning daycare or overnight boarding, that the behavior of my dog or of other dogs cannot be guaranteed.
*
I understand that I am solely responsible for the medical treatment of any conditions or injuries that my dog receives while at or as a result of participating in the daycare and/or boarding program of The Canine Connection even if those injuries are the result of the behavior of another dog.
*
I understand that the social behavior of my dog and other dogs may change over time. I further understand that it is possible that at a future time my dog may no longer enjoy or benefit from the daycare or boarding environment at The Canine Connection and may be removed from this group play environment.
*
I understand that the following approaches may be used to manage my dog’s behaviors within a group environment and I approve the use of these strategies with my dog: food or treats as a reward, crates, kennel suites, and other confinement areas for rest and time-outs, water or citronella spray to break up dog-dog altercations, stuffed Kong toys to alleviate boredom, walks in the neighborhood for exercise and mental stimulation. I accept the use of these and any other approaches for managing dog behavior that are deemed appropriate by The Canine Connection.
*
I allow my dog to be photographed, videotaped, and/or used in any media or advertising without prior approval by me. All such photographs, videos, and images are the property of The Canine Connection.
*
I understand that payment for services is expected at the time my dog is dropped off for daycare or picked up boarding and that a reservation fee may be required for services.
*
I understand that there is a capacity limit to The Canine Connection’s daycare and boarding program and I am therefore required to make advance reservations for these services. I further realize that my request for reservations may not be granted if capacity for a given day has already been reached.
*
I understand that I must notify The Canine Connection at least 24 hours in advance should I need to cancel a daycare and 48 hours in advance to cancel a boarding reservation. Failure to notify the Canine Connection in advance will result in my being charged in full for the reservation.
*
I understand that prepaid daycare days cannot be used as a credit toward boarding stays, training, or retail purchases and vice versa.
*
I understand that I will be charged, and I agree to pay, a late or early pick up fee and if I drop off my dog before 7am or collect my dog after 6 pm. I further understand that the earliest possible drop-off is 6:00 am and latest possible pick-up time is 8:00 pm.
*
I understand that if I have not picked my dog up by the 8:00 pm, my dog will be admitted to overnight boarding and I will pay the overnight boarding fee.
*
I understand that prices are subject to change and that new prices will be in effect when posted on The Canine Connection’s web site.
*
I understand and accept all the terms and conditions of this agreement.
*
Please type your name here to represent your signature indicating your acceptance of all terms and conditions of this agreement.
*
Comments
