EmailMe Form - Dog Daycare Client Registration Form

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Name *

First Last

Address *

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

Email *

Confirm

Date you would like to book first day? *

MM / DD / YY

Requested dates need to be confirmed.

Work Phone *

### - ### - ####

Home Phone *

### - ### - ####

Cell Phone *

### - ### - ####

DOG's Name *

First Last

Dog's Age (estimate if not known) *

Dog Breed *

Dog Sex *

Color/Description

Health Problems or Allergies?
If Yes, please list in comments section below.

Yes

No

Is your dog *

Social with dogs

Social with people

Fearful

exhibiting behaviour issues

one that has bitten (broken skin) a dog or human in the past?

Other (Enter in comments below)

Check off all that apply

History *

My dog has attended another Dog Daycare

My dog has had a history of being reactive with other dogs

My dog is a puppy and is just learning social skills

Other - please enter in comments section below

Check off all that apply
Please note that Puptown reserves the right to refuse any dog. We are happy to discuss with you.

Comments:

Please list any health and/or behavior concerns here. Also any additional comments you want to share with us.

Is your dog crate trained? *

Yes my dog is comfortable in a crate or a dog run

No my dog does not do well in confinement

I have never confined my dog to a crate or a kennel so I don't know what he/she will be like.

Sometimes we have to put a dog in a time out for rest, feeding or behaviour.

Emergency Contact *

First Last

This person should be available to pick up your dog, take to the vet etc.

Emergency Contact Cell # *

### - ### - ####

2nd Emergency Contact Name

First Last

If available

Emergency contact alternate number

### - ### - ####

Veterinary Clinic Name: *

First Last

Veterinary Clinic Phone # *

### - ### - ####

Scan and Upload Vaccine Records for current Rabies, Regular Core Vaccines and Kennel Cough.

OPTIONAL. If you are unable to scan and upload your dog's vaccine records, please bring a printed COPY with you. You can also request your Vet office to email us a copy to wagwaterloo@gmail.com

Date of Most Recent Rabies Vaccine.

MM / YY

Vaccine records are required for acceptance. Please submit your dog's vaccine record. Puppies under age 4months are too young for rabies vaccine.

Date of Most Recent Bordetella Vaccine
(Kennel Cough)

MM / YY

Puppies under 4months are too young for this vaccine.

Fecal Report with Negative Giardia (All Puppies under 6months)

This is highly recommended for all dogs 6months of age and younger.

Should Your pet require medical care while in our care, and we are unable to reach you, you understand that every effort will be made to contact you. in the event that you or your emergency contact cannot be reached, you acknowledge that delays in treatment may result in worsening of your dog's condition, or even death. In the unlikely event that your dog has an emergency, you agree to appoint Puptown full care, custody and control. I understand that there is an assumption of risk to my dog and myself attending such a facility and I agree not to hold the company, its employees, agents, associates and landlords liable and waive my right to any claims against such. *

Please Treat my dog with whatever is necessary to safeguard my dog's health, including surgery and transfer to emergency veterinary clinic/hospital. I understand that I will be responsible for all costs incurred

Please treat my dog with whatever is necessary but do not exceed the cost of $500 without consulting me. I understand that cost limitation may be detrimental to my dog and may even result in death.

Please treat my dog with whatever is necessary but do not exceed the cost of $1000 without consulting me. I understand that cost limitation may be detrimental to my dog and may even result in death.

Choose ONE of the above treatment options

I agree to the terms and conditions on this form and have read, understood and agreed to the company policies. I understand that if I schedule dates for daycare, and do not give 2 business days notice of a change or cancellation, that I am responsible to pay for that booking. I understand that there are no refunds with the only exception being that my dog was excused from a program or service.
I also understand that, like children in school, dogs can catch colds and that can be very contagious before there are any symptoms showing. I agree to not bring my dog to daycare if my dog should be exhibiting any sign of illness including but not limited to, diarrhea, loose stools, bloody stools, coughing, fever, discharge etc. *

Clear

Use your touch pad or mouse to sign here.

How did you hear about PUPTOWN?

Orientation - I will read the email and if I have any questions, I will be sure to ask. *

Understood

You will receive an automated email following your submission of this form. Please check your SPAM folder if you don' see it in your Inbox. Thank you.