Registration Information

(print form and fill out prior to first visit)

Owner Information
Name: ________________________________________________________________
Address: ______________________________________________________________
Home phone: ___________________________ Work Phone:____________________
Email: _______________________________________
Is it ok to send pictures/updates to this email?  Y / N
Cell Phone: ___________________________
 
Emergency Contact – Other than yourself
Name: ________________________________________________________________
Home phone: __________________________ Work phone: ______________________
List any person authorized to pick-up your dog if you cannot:
_______________________________________________________________________

Pet Information
Name: ________________________ Breed: ___________________ Sex: ___________
Age: ________________ Weight: ________________   Birthdate:  ________________
Veterinarian
Name: ________________________________________________________________
Address: ______________________________________________________________
Phone: ______________________________________

General Information
Dog's Name: ___________________  
Where did you get your dog? _______________________________________________
If adopted, do you have any knowledge of your dog's past history? _____________
_______________________________________________________________________
How many days a week are you considering doggy daycare? _________
Preferred days______________________________________________
How did you hear about Adorable Pooches Palace? _____________________________
Health/Grooming
At what age was your dog spayed/neutered? ___________________________________
Is your dog current on ALL vaccinations?_______yes________no
Is your dog currently on heartworm prevention? ________________
What flea program is your dog on? ________________________________________________
Is your dog on any medications?  If so please list ____________________________________
What type of dog food do you feed your dog?________________________________________
Is it okay to give your dog treats during the day?______________________________________
Does your dog have hip dysplasia? ________ yes ________ no
If yes, what restrictions need to be placed on your dog's activities or movements?
_____________________________________________________________________________
Does your dog have any allergies? ________________________________________________
Does your dog like to be brushed? ________ yes ________ no
Do you regularly clean your dogs teeth_________ ears__________?
How does your dog react to having his/her nails clipped? ______________________________
Does your dog have any sensitive areas on his/her body? _____________________________

Behavior
Does your dog act afraid of any specific items or noises? If so, please explain: ____________
_____________________________________________________________________________
Are there any kinds of dogs your dog automatically fears or dislikes? ____________________
_____________________________________________________________________________
How does your dog react to puppies? ______________________________________________
Where does your dog sleep at home? (In bed, crate, dog bed)___________________________
Has your dog ever:
Growled at someone? ______ yes _______ no
What were the circumstances: ____________________________________________________
________________________________________________________________
Bitten someone? ______ yes ________ no
What were the circumstances: ____________________________________________________
________________________________________________________________
Does your dog have any problems in any of the following areas: (if so, please explain)
Housetraining: ___________________________________________________________
Barking: _______________________________________________________________
Jumping: ______________________________________________________________
Others: ________________________________________________________________
Has your dog ever growled or snapped at anyone who has taken his/her food or
toys away from him/her? ________ yes ________ no
Has your dog ever shared his/her food or toys with other animals? __________________
Does you dog play with any toys? ______ yes ______ no
If yes, what kind of toys does your dog like and what games does he/she play?
_______________________________________________________________________
How often does your dog meet new dogs it does not already know? _________________
Has your dog ever been in a dog fight?  If so what happened? ______________________
________________________________________________________________________
________________________________________________________________________
Has your dog ever had any formal obedience training? ______ yes ______ no
If yes, when and where? ___________________________________________________
What commands does your dog know? ________________________________________
Does your dog know a bathroom command? ____________________________________
Does your dog know a quiet command? _______________________________________
Does your dog know any play commands? _____________________________________
Other comments about your dog that you feel might be helpful:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Health and Temperament Certification
I, _______________________________, hereby certify that my
dog ___________________  is in good health and has not been ill with any
communicable condition in the last 30 days.
I further certify that my dog has not harmed or shown aggressive or
threatening behavior towards any person or any other dog.
 
Date: __________   Signature of Owner:____________________    

*Please attach copy of vet records showing dates of vaccinations and bordatella      
 

Terms and Conditions Agreement

1. I understand that I am solely responsible for any harm caused by my
dog while my dog is attending daycare at Adorable Pooches Palace or is using
any other services provided by Adorable Pooches Palace.
2. I further understand and agree in admitting my dog that Adorable
Pooches Palace 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.
3. I further understand and agree that Adorable Pooches Palace and their
staff and volunteers will not be liable for any problems that develop provided
reasonable care and precautions are followed.  I hereby release Adorable Pooches
Palace, their staff, and volunteers of any liability of any kind whatsoever
arising from my dogs’ attendance and participation at Adorable Pooches Palace.
4. I further understand and agree that any problem that develops with my dog
will be treated as deemed best by the staff at Adorable Pooches Palace, in their
sole discretion, and that I will assume full financial responsibility for any and
all expenses involved.  I authorize Adorable Pooches Palace to obtain medical
records and/or treatments for my dog in the event of injury or illness from my
veterinarian or from the closest veterinary clinic.  By signing this document I
further direct said veterinarian to provide such records upon request.
5. I further understand that if I fail to provide proof of current
vaccinations or if my dogs’ vaccinations are found to be expired or otherwise
incomplete, Adorable Pooches Palace has the right to refuse service until current
proof is provided.  If my dog arrives at the facility with fleas and/or other
parasites, Adorable Pooches Palace has the right to bathe and quarantine my dog
until picked up by myself or my agent, and I take full responsibility for any
expenses incurred for such reasons.
6. I further understand that my dog may experience minor cuts, scratches,
and abrasions due to the nature of dog play.  I realize that pads on paws may
initially become sensitive, or bothered until my dog becomes used to running
on different surfaces.
7. I further understand that Adorable Pooches Palace is a place where animals
co-mingle in groups and I am responsible for the medical treatment of any injuries
that my dog receives while at Adorable Pooches Palace.
8. I allow my dog to be photographed, videotaped, and/or used in any media or
advertising without prior approval by me.  All such photographs, ect. are the
property of Adorable Pooches Palace.

I certify that I have read and understand the terms and conditions set forth on this
page, the application, and health forms.  I agree to abide by the terms and conditions
and accept all terms, conditions, and statements of this agreement.

Name of owner and dog (please print): _____________________________________

Signature of owner:    _____________________________________

Date:   _____________________________________