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Doggy Day Care Boarding Grooming
*Name:
*Phone number:
*Phone number:*Address: *Email address:
*Email address:Address 2: *City: *State: *Zip Code:
*City: *State: *Zip Code:*Emergency Contact: *Phone number:
*Phone number:Veterinary & Pet Information
*Veterinarian:
*How did you hear about us?
*Dog's Name:*Breed:
*Breed:* *Spayed/Neutered:
*Spayed/Neutered: *Weight: *Age: yrs. mos. *Medications:
*Age: yrs. mos. *Medications: Medical information:
Satisfied Clients
Doggy Day Care Boarding Grooming
Daycare Registration Form
*Medical care: If in our judgement, your dog requires medical care, you agree to be solely responsible for the payment of all medical bills for your dog and you release Unleashed, LLC, its officers, directors, agents and employees of and from any and all responsibility for, or claims, damaages or debts arising out of or related to such medical care, including but not limited to: transportation to/from the veterinarian clinic and choice of veterinarian or animal hospital.
*Initials
*Vaccinations:
(*every 6 mos.)
Authorized Pickup*
By checking here, you agree that you may verbally (by telephone) or in writing (by facsimile or otherwise) request that Unleashed, LLC release your dog to someone other than the person(s) listed as owner and you release Unleashed, LLC of and from any and all responsibility for releasing your dog to any person(s) Unleashed, LLC believes to be authorized by you.
(*Photo ID will be required)
*Method of flea control
*Has your dog ever attended Doggy Day care?
*Has your dog ever exhibited aggressive behavior towards people or other dogs?
If yes, please explain:
Day Care history and temperament
*Is your dog a jumper, climber or escape artist?
If yes, please explain:
