Doggie Daycare/Puppy Play Temperament Application & Waiver

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We love dogs, and we want your dog to love coming to our Doggie Daycare and Puppy Play. No one knows your dog better than you, so we would appreciate you taking the time to fill out this application. Along with it, please provide all vaccination records. The more we know about the dogs in our care, the better our playgroups will be.

Owner's Name

First

Last

Secondary Owner's Name

First

Last

Daytime Phone

Email

Emergency Contact Name

First

Last

Emergency Contact Phone

Dog Information

Dog's Name

Breed

If a mix, list two predominant breeds

Current Age

How long have you owned your dog?

Sex

Male

Female

Is your dog spayed or neutered?

Yes

No

Expiration Date of Rabies Vaccine

Expiration Date of Bordetella Vaccine

Expiration Date of DHPP (L) Vaccine

Expiration Date of Lyme Vaccine

Expiration Date of Lepto Vaccine

Has your dog had any other vaccines?

Yes

No

Please list other vaccine(s) and expiration date(s)

Upload Vaccination Records

Maximum file size: 52.43MB

Where did you get your dog? Where did you get your dog?

What knowledge do you have of your dog's history?

Why are you considering our daycare program for your dog? (Check all that apply)

Play with other dogs

So not home alone

Exercise

Recommended by another pet professional (trainer, vet, etc.)

OtherOther

Please indicate if your pet has symptoms of separation anxiety

Yes

No

Please list symptoms

What kind of exercise are you looking for?

Please list the reason(s)

Which of the following best describes your dog's level of socialization with other dogs?

None - no knowledge of other dog interaction

Minimal - on leash encounters only

Moderate - some off leash playtime on occasion with visitor's/neighbor's/friend's dog(s)

Extensive - Regular visits to dog social events, off-leash dog parks, dog daycare, etc.

Has your dog had any problems previously in an off-leash social environment?

Yes

No

Check all that apply

Altercation or fight at a public dog park

Altercation or fight with a neighbor or friend's dog

Fearful reaction in a group of dogs

Dismissed from a prior dog daycare or social playgroup program

Other (please describe)Other (please describe)

What reason were you given as to why your dog was dismissed?

Provide any other comments you want us to know about this situation

Please describe your dog's flea/tick control and prevention program

Does your dog have any allergies?

Yes

No

Please explain

Does your dog have any physical disabilities?

Yes

No

Please explain disability and cause

What restrictions need to be placed on your dog's activities or movements?

Does your dog have any medical conditions or prior surgeries?

Yes

No

Please explain

Is medication used to control the condition?

Yes

No

Please provide name and dosage

On what type of surface does your dog generally go to the bathroom (grass, rock, concrete)?

Does your dog have any bathroom-related issues or concerns?

Yes

No

Does your dog have any sensitive areas on his/her body?

Yes

No

Where are they located?

Where are your dog's favorite petting spots?

How frequently is your dog walked outside?

How long are your walks?

Check the box below that best represents your dog's overall level of exercise routine?

Couch Potato: spends days sleeping, occasional walks and/or playtime with humans or dogs

Mild Exerciser: short daily walks and/or regular playtime with human or dogs

Moderate Exerciser: long or multiple walks daily and/or regular playtime with human or dogs

Athlete: regular jogs/runs and/or regular participation in a dog sport activity such as agility, flyball, frisbee, etc.

Please add information about other pets in the household:

Household Information

Pet's Name

Breed

Age

Sex

Male

Female

Is the pet spayed or neutered?

Yes

No

ADD A PET REMOVE A PET

Do you have cats?

Yes

No

Does your dog get along with your cats?

Yes

No

Does your pet get along with other household pets?

Yes

No

How does your dog react to unfamiliar cats or small animals they see on walks?

Does your dog like children?

Yes

No

How does your dog behave around children?

Do any visitors bring their dog(s) to your house?

Yes

No

How do they get along?

Are there any types or sizes of dogs your dog seems to automatically fear or dislike?

Yes

No

Please explain

How does your dog react to puppies?

How does your dog react to another dog approaching him/her in a park, at a beach, or on a walk?

How does your dog act on leash?

How does your dog react off leash?

Has your dog ever shared his/her food or toys with other animals?

Yes

No

How does your dog react to another dog approaching his/her food or toys?

Which commands does your dog know? Please check all that apply

How did your dog get his/her obedience training? Please check all that apply

Attended one group class

Attended more than one level of group classes (beginner and intermediate, etc.)

Dog was sent to a board and train program

Private lessons in home

OtherOther

Has your dog ever gotten away from someone when out for a walk or jumped a fence?

Yes

No

Please explain

Does your dog have any problems in any of the following areas? Please check all that apply

Please explain

Does your dog know any tricks?

Dog Behavior Information

Has your dog ever growled at someone?

Yes

No

What were the circumstances and how did you respond?

Has your dog ever bitten a person?

Yes

No

What were the circumstances and how did you respond?

Has your dog ever bitten another animal?

Yes

No

What were the circumstances and how did you respond? Please describe injuries (if any)

Is your dog frightened by thunderstorms?

Yes

No

Describe typical behavior and what specifically helps to relax your dog or calm his/her fear

Thank you for the time you spent completing the application form. We look forward to meeting you and your dog on the scheduled temperament test day. Please contact us if you have any questions on the next steps of the temperament test process.

**Please sign that you have read and understand the following Owner Agreement**

Owner Agreement

By submitting this Temperament Test Application, I am requesting that the staff of Embassy Veterinary Center evaluate and determine, in its sole judgment, whether my pet may be suitable for participating in the Doggie Daycare program and/or other social programs hosted by Embassy Veterinary Center. I understand and hereby agree that:

a) Embassy Veterinary Center, in order to admit my dog(s) to participate in such social activities, has relied on my representation that my dog is in good health and has not been ill with any communicable disease in the last 30 days, and I agree to inform Embassy Veterinary Center of any such communicable disease that my pet contracts in the future. Further, my dog has not harmed or shown aggressive or threatening behavior towards any person or any other dog.

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b) I understand that Orthopedic injuries such as, but not limited to, Torn Cruciate Ligaments, Medial Patella luxation, Carpal or Tarsal injuries, and Hip or Elbow injuries are common injuries that can occur in dogs. I agree that should such injury occur, while, or during Embassy Veterinary Center Doggie Day Care, I hold harmless Embassy Veterinary Center, its Doctors, Staff, and employees from any liability. I waive my rights to pursue any action against Embassy Veterinary Center for any orthopedic injury. I am responsible for any cost related to such injury and repair.

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I am solely responsible for any harm caused by my dog while it is attending Embassy Veterinary Center’s Doggie Daycare or any other social activities.

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d) Embassy Veterinary Center and its staff will not be held responsible for any problems that develop and I hereby release them of any liability of any kind whatsoever arising from my dog's attendance in Doggie Daycare or other social activities.

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e) Any problem that may develop with my dog will be treated as deemed best by the staff of Embassy Veterinary Center, in their sole discretion, and I assume full financial responsibility for any and all expenses involved.

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f) My dog is always on probation and can be excused from the daycare program at any time for good cause, as deemed by Embassy Veterinary Center staff; my dog can always be retested in the future if I can demonstrate I have remedied the issue to the best of my ability.

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g) I consent to Embassy Veterinary Center taking pictures or videos of my pet and I give permission for these images to be used in any matter, including social media, that they choose. This includes but is not limited to social media, Facebook, and advertising.

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I hereby certify that I have read and understood this agreement. I agree to abide by and accept, all terms, conditions, and statements of this agreement.

Owner Signature

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