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Dog(s) Name:*
Dog(s) Age:*
Dog(s) Breed:*
Date(s) of Adoption:
How did you hear about us?Tulsa Pet MagazineOther MediaFriend or RelativeReferral
If referral, please list:
Is your dog: Spayed / NeuteredIntact
If not, which dog(s) are intact?:
Approx. Weight(s):
Address and phone number, if known:
Date of most recent vet visit and results:
Any current medical issues we should be aware of?* YesNo
Any medications we need to administer while your dog is at daycare?* YesNo
Current on vaccinations?* RabiesBordetella (kennel cough)Distemper/Parvovirus
A copy of your dog’s most recent vaccination record must be emailed or uploaded to us using this form, by you or your veterinarian prior to your dog’s first visit to Dogville. Our email address is info@dogville-daycare.com.
Current on heartworm preventative?* YesNo
Is your dog on monthly flea/tick preventative?* YesNo
The answers to these questions will help us gauge our ability to provide the most appropriate and enjoyable stay and environment for your dog—please answer them as completely as possible. If multiple dogs, please specify by name when adding comments.
Has your dog ever gone to daycare before? YesNo
Does your dog have any toys he or she prefers not to share with other dogs? YesNo
How does your dog respond when another dog approaches where he or she is resting?:
What about when another dog approaches you?:
Does that change if you have food or treats?
How does your dog let other dogs know he or she doesn’t want to share? Please be specific.
Does (dog’s name) have any toys he or she prefers not to share with humans? NoYes
What does your dog do when a person reaches for something he or she has?
How does your dog respond when a person approaches where she’s resting?
What about when another person approaches you?
Does that change if you have food or treats? YesNo
How does your dog let people know he doesn’t want to share?
How many dog friends does your dog have? ManyA FewOne or TwoNone
How often does your dog have a chance to meet new dogs: WeeklyOccasionallyRarely
Would you say that your dog warms up to new dogs: QuicklySlowly upon first meetingOver many meetingsNever
Would you say that your dog is most comfortable: Touching and interacting with other dogsBeing near but not interactingAt a distanceNot at all
What does your dog do when he or she meets a new dog for the first time?
Has your dog ever had a spat with another dog: YesNo
What kind of dog does your dog prefer to play with? Big DogsSmall DogsMid-size DogsOlder DogsYoung DogsRowdy / Energetic DogsLaid Back DogsOther / Not Listed
What kind of dog does your dog prefer NOT to play with? Big DogsSmall DogsMid-size DogsOlder DogsYoung DogsRowdy / Energetic DogsLaid Back DogsOther / Not Listed
Additional Comments
What does your dog do when he or she sees another dog while she’s on leash?
What does your dog do when he or she sees another dog when she’s behind a fence or looking out through a window, such as at home or in the car?
Has your dog ever jumped or climbed a fence or barrier? YesNo
Would you say that he or she warms up to new people: ImmediatelyQuicklyIt takes some time
The following questions have to do with how comfortable your dog is when being in the following situations
Having his or her collar put on and taken off?Loves itTolerates itHates it
How can you tell?
Having his or her leash put on and taken off? Loves itTolerates itHates it
Being picked up, petted, and hugged? Loves itTolerates itHates it
Has your dog ever had bitten or snapped at a person? YesNo
Are there any other concerns you have or information you would like to share with us about your dog? YesNo
1. (Dogville Daycare & Boarding) will endeavor to offer only sound, safe, and responsible care for my dog(s). However, I have been told that in order for my dog(s) at attend daycare or boarding that they must be vaccinated every 6 months for Kennel Cough. I also understand the risks inherent in boarding my dog, including but not limited to interactions with other dogs and potential exposure to disease and parasites and that just because my dog(s) have been vaccinated for kennel cough that does not mean they are 100% protected from getting the disease. Further, I am and will remain responsible for the actions of my dog at all times and I hereby agree to indemnify and hold harmless (Dogville Daycare & Boarding) of any and all claims of illness, injury, expense, costs, or damages caused by the actions of my dog while under (Dogville Daycare & Boarding’s) care. I have been told by (Dogville Daycare & Boarding) and understand the inherent risks of owning a dog, including but not limited to the risk of dog bites to myself or others. I recognize that (Dogville Daycare & Boarding) is not responsible for any unintentional errors, omissions, or incorrect assertions. I understand that the recommendation of any other product or service is not a guarantee of my satisfaction with that product or service. -------------------------------------------------------------- 2. I authorize emergency medical care to be provided for my dog(s) by the above-named veterinarian, or an appropriate alternate to be determined by (Dogville Daycare & Boarding) in the event that my regular veterinarian is not available or that closer care is required. I will reimburse (Dogville Daycare & Boarding) for any charges related to emergency care. -------------------------------------------------------------- 3. Payment Policy: Payment is due at the time dog(s) is/are picked up from Dogville. Credit cards and cash are accepted for payment. Checks must be pre-approved by management. Returned checks will be charged a $25 fee. -------------------------------------------------------------- 4. Cancellation Policy: Cancellations are to be submitted at least 24 hours in advance of reservation. -------------------------------------------------------------- 5. Grooming Policy: Any dog that arrives with fleas will be given a dose of Capstar at owner’s expense ($25/dose) and kept quarantined from other dogs until fleas are gone. -------------------------------------------------------------- 6. Stress-induced diarrhea. I understand that boarding dogs may arrive with or develop diarrhea as a condition of stress related to separation from an owner and the uncertainty of the owner’s return. This may result in a need to supplement or modify the dog’s normal diet with products that contain high fiber content and probiotics to regain the normal balance of intestinal flora during a prolonged stay. When this occurs, I understand that I will be notified by Dogville staff and that there will be an additional charge for each feeding containing these ingredients. If the diarrhea progresses to the point that medical intervention is needed, I will be informed by Dogville Staff (or my emergency contact will be notified in the event I cannot be reached) and I will be responsible for any additional costs related to veterinary care or prescribed medication.
I DODO NOT authorize (Dogville Daycare & Boarding) to administer or seek 1st aid and resuscitative care for my dog(s) as determined appropriate by (Dogville Daycare & Boarding) and I agree to indemnify and hold harmless (Dogville Daycare & Boarding) for all and any results thereof.
I Agree to the Liability Waiver & Policies
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