Buffalo NY Premier Dog Trainer, Professional Dog Obedience Services

Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Mobile Phone #*

Home Phone

Work Phone

Email*

Emergency Contact

Name*

First Last

Home Phone

Work Phone

Cell Phone

Relation*

Authorized for pick up?*

Pet Information

Dog's Name*

Age*

Dogs over 6 months must be spayed or neutered to attend Daycare.

Sex*

Male
Female

Spayed / neutered?*

Breed*

Color / Markings*

Medical Information

Veterinary Clinic Name*

Medical Background

Is your dog allowed treats?

Microchip?*

Flea / Tick Medication?*

Dog must be on a flea and tick preventative to attend our daycare program.

Currently taking medication?*

If yes, please list:

Any known allergies?*

If yes, please list:

Any health concerns to be aware of?*

If yes, please list:

Behavior Information

Has your dog received any type of training?*

If yes, please list when as well as the type of training (Example: Puppy Class, Basic Obedience, etc)

If comfortable, please let us know the name of the training facility/trainer you have used.

Is your dog ever crated or confined at home?*

**We sometimes need to give dogs downtime during the day and we would like them to be as comfortable as possible when we do.

If yes, please let us know what type of confinement you use (Crate, x-pen, a small room (IE laundry room, bedroom, etc).

Has your dog ever been excused from a Daycare or playgroup?*

If yes, please describe the circumstances and the reason the Daycare gave for excusing your dog.*

If comfortable, please let us know the name of the Daycare your dog attended.

Does your dog currently any Daycares or playgroups?*

If yes, how frequently does your dog attend?*

Has your dog shown any aggression towards or bitten humans?*

Did it break the skin?*

Please describe the incident, including any medical attention required

Has your dog shown any aggression towards or bitten other dogs?*

Did it break the skin?*

Please describe the incident, including any medical/veterinary attention required*

Does your dog display any other behaviors of concern around other dogs? (possessive of toys, leash reactivity, etc.)*

If yes, please describe:

Any additional information that we should know?

How many times per week do you plan on treating your dog to daycare?*

Vaccine Records

If you have access to digital copies of your vaccine certificates, please upload here. Otherwise please fax Vaccine Certificates to (716) 931-5921. (Rabies, Kennel Cough/Bordatella, and DHPP are required)

Drop files here or

How did you hear about us?

Pet Care Agreement*

LIABILITY RELEASE AND PET CARE AGREEMENT

1. I certify that my dog is in good health and has received all required vaccinations, including: canine distemper, parvo virus, hepatitis, parainfluenza, bordetella, and rabies; that my dog is free from fleas, ticks, heartworms, and all other parasites; and that if my dog is older than six months of age, he or she has been neutered or spayed. I agree that I am under a continuing obligation to report to K9 Connection any sign of illness or infection in my dog.

2. I agree that in the unlikely event that my dog requires emergency veterinary treatment while at dog day care or boarding, K9 Connection, in its sole discretion, will transport my dog to an appropriate veterinary facility for treatment and will immediately attempt to contact me. I assume all financial responsibility for veterinary treatment.

3. K9 Connection strives to keep a clean and sanitary environment. I understand that even in cleanest environments, infections, diseases, and parasites may be transmitted between animals.

4. I understand and agree that my dog may be placed in a kennel for periods of time during the day and/or night to allow for rest and downtime.

5. I certify that my dog has not injured or shown aggression or threatening behavior to any person, dog, or other animal.

6. I understand that dogs are animals and even in the most controlled and well-supervised environments, they may engage in inappropriate animal behavior. This includes, but is not limited to, rough playing, nipping, aggression, and dog bites. I further understand that although K9 Connection staff closely monitors dog socialization and play to prevent injury, it is possible that my dog may receive minor nicks and scratches from other dogs. I agree that K9 Connection may use “corrections” to interrupt and/or stop my dog’s inappropriate behavior. Such corrections include, but are not limited to, the use of spray bottles of water and compressed air canisters.

7. I agree that in the event that my dog engages in an act of aggression toward another dog or person, K9 Connection staff may use reasonable physical force to interrupt and stop the aggression. I further agree that I am solely responsible, financially or otherwise, for any harm or damage to other dogs, persons, and/or property arising out of my dog’s behavior.

8. I understand that payment in full is required at the time of pickup of my dog. If my dog is not picked up on time, I authorize K9 Connection to take whatever action it deems necessary, in its sole discretion, for the continuing care of my dog. I will pay K9 Connection the cost of any such continuing care.

9. I understand that any unused prepaid Dog Day Care packages will expire six months after day of purchase.

10. I agree to allow K9 Connection to photograph and/or videotape my dog for use in print, publication, and promotion of K9 Connection.

Acknowledgement of Risk:

I understand that attendance and participation in K9 Connection dog day care and boarding is not without risk to myself, to my dog(s), and/or to third parties, and/or the dog(s) of third parties.

The risks include, but are not limited to, the risk of property damage, personal injury from dog bites, scratches, or other injuries, death, infectious disease, and parasites. I agree that my dog’s attendance and participation in K9 Connection dog day care and boarding is voluntary and was undertaken with my knowledge of the known risks and other risks that may result from my dog’s participation in dog day care and boarding.

Assumption of Risk:

I agree that I have been informed of the risks associated with dog day care and boarding, and have assumed the risk of my dog’s attendance and participation in K9 Connection dog day care and boarding.

Release of Liability:

In consideration for my dog’s attendance and participation in K9 Connection dog day care and boarding, I fully release K9 Connection from any and all claims and/or liability arising out of my dog’s attendance at, or participation in, dog day care and boarding, including all claims for personal injury, wrongful death, and property damage. I agree to defend, indemnify, and hold harmless K9 Connection from any and all claims and costs, including attorney’s fees, arising out of or relating to my dog’s attendance at, or participation in, K9 Connection dog day care and boarding, including claims of negligence against K9 Connection, it’s employees, officers, agents and/or volunteers.

Typing your name here Acknowledges that you have carefully read, and agree to our Liability Release and Training Agreement*

First Last

Date*

Signature*

Sign above to consent to Liability Release and Training Agreement.

Untitled

Dog Daycare Application

Personal Information

Emergency Contact

Pet Information

Medical Information

Medical Background

Behavior Information

LIABILITY RELEASE AND PET CARE AGREEMENT

Acknowledgement of Risk:

Assumption of Risk:

Release of Liability:

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