Doggie Daycare Application

Instructions : If you have more than one dog, each dog will need a separate form.

You do not, however, need to repeat the information about yourself.

Parent Information

Name  ___________________________________________________________________

Address  _________________________________________________________________

City  ______________________  Province/State  ________________________

Postal Code/Zip ___________________________________________________________

Home Phone  _________________ Emergency Phone  ____________________________

Work Phone  _________________  Cell Phone/Pager  ____________________________

Email  ___________________________________________________________________

Who else is authorized to drop off/pick up the dog (s)? ___________________________

_________________________________________________________________________

Instructions in Case of Emergency  ___________________________________________

_______________________________________________________________________

How did you hear about us?  ________________________________________________

Your Dog's Information

Name  ________________  Breed  _______________________  Age  _________

Sex :   Male/Female                Spayed/Neutered :  Yes/No*

* If Female Unspayed, Date of Last Cycle  _____________________________________

Weight  _____________  Colour  _____________________________________________

How does your dog get along with other dogs?  _________________________________

People?  __________________________________________________________________

Has your dog used any daycare/boarding facility before?   Yes*/No

*If yes, where?  ____________________________________________________________

Your Dog's Health

Veterinarian/Clinic  ________________________________________________________

_________________________________________________________________________

Address  _________________________________________________________________

Phone Number  ___________________________________________________________

Please describe your pet's general health (include current medical conditions) 

_________________________________________________________________________

_________________________________________________________________________

Allergies (if any)  __________________________________________________________

_________________________________________________________________________

Current Medications  ______________________________________________________

Frequency & Time Administered  ____________________________________________

What Flea & Tick Prevention Treatment is Used?  ______________________________

_________________________________________________________________________

**Vaccination Record - Please attach a copy from your vet's office.**

Your Dog's Routine

Daycare Drop Off/Pick Up Time  ____________________________________________

Regular Food : Brand _______________________   Feed Times  ___________________

Quantity  ____________  Instruction  _________________________________________

Exercise/Walk  _____________________________  Times  ____________________

Favorite Activities/Toys/Buzz Words  _________________________________________

_________________________________________________________________________

Items Brought ____________________________________________________________

_________________________________________________________________________

Agreement

I certify that I am the owner or agent of the owner of the aforementioned dog, and that

I am authorized to bring the dog to daycare and sign this form. I authorize Mountain

Dog Lodge to contact my veterinarian in order to confirm health, temperament, and

vaccinations. I give consent to Mountain Dog Lodge to act on my behalf by obtaining

veterinary care at my expense, should Mountain Dog Lodge deem it necessary. I have read

the schedule of fees and agreed to pay all charges at checkout, unless previously arranged.

I release Mountain Dog Lodge (and its agents and employees) from any liability or claim

due to injury or death of my dog, unless Mountain Dog Lodge has been negligent in the

care of my dog. I understand that under no circumstances will Mountain Dog Lodge be

liable for consequential damages or demands beyond the replacement value of my dog.

Signed  ____________________________  Date  ___________________

                  **Uncancelled Reservations MUST Be Paid In Full**

                                                       Thank you!!

Mountain Dog Lodge