New Client Dog Daycare Reservation Request Form
Welcome to the Dogs On The Farm family! 
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Owner Name (First Last) *
Cell Phone *
Additional Owner Name (First Last)
Additional Owner Cell Phone
Email Address(es) *
Emergency contact info *
Street address *
City *
State *
Zip Code *
Veterinarian Practcie & Phone Number *
How did you hear about Dogs On The Farm? *
Dog Name *
Dog Breed *
Sex *
Birthdate *
MM
/
DD
/
YYYY
Color *
MM
/
DD
/
YYYY
Weight *
Date Requested *
MM
/
DD
/
YYYY
Type *
Select Activity Package *
Select A La Carte Activities *
Brand of food: *
Breakfast Instructions: *
Dinner Instructions: *
Snacks/Treats/Other:
If your dog isn't eating can he/she have an incentive (can food, chicken, peanut butter, cheese, etc?) *
Required
Please list any medications, dosage/instructions, and reason for medications:
Health Issues:
Limitations on movement (hip dysplasia, arthritis, old injury, etc):
Does your dog's activity need to be restricted in any way?:
Is your dog unusually heat sensitive? (outside play is limited when 'feels like' temperature is over 80 degrees and no outside play when 'feels like' temperature is over 85 degrees)
Clear selection
Does your dog regularly cough or have diarrhea/vomiting?
Is your dog scared of any specific items or noises?
Are there any people (like men, peopel wearing hats, etc) or dogs (breeds, sizes, etc) your dog fears or dislikes?
Does your dog tend to jump or climb fences or escape yards?
Clear selection
How would you describe your dog's personality?
How would you describe your dog's energy level?
Clear selection
Does your dog have any training? Do they know commands like sit / stay / come when called / loose leash walking?
(If doing group play) How does your dog get along with other dogs?
(If doing group play) How long have you had your dog?
(If doing group play) If rescued, what do you know about your dog's history?
(If doing group play) Why are you interested in group play for your dog?
(If doing group play) Describe your dog's experience with group play, including any issues they have had:
(If doing group play) How does your dog react to a stranger coming in the house?
(If doing group play) Does your dog bark at people/dogs outside your house?
(If doing group play) How does your dog react to another dog approaching on leash?:
(If doing group play) Does your dog chase squirrels, bikes, etc?
(If doing group play) Does your dog like puppies?
(If doing group play) Does your dog mount/hump, jump on people, mouth, bark excssively, or have other problem behavior?
Please add any other notes you think might be helpful:

Owner Agreement/Release of Liability


I hereby certify that I have read and understand the following:

I certify that my dog(s) have not harmed or shown aggressive or threatening behavior towards any person or any other dog.  I understand that I am solely responsible for any harm caused by my dog(s) while my dog(s) is/are attending Dogs On The Farm (Center).

I further understand and agree that in admitting my dog(s) to the Center, Dogs On The Farm staff have relied on my representation that my dog(s) is/are in good health and have not been ill with any communicable condition in the last 30 days.

I further understand and agree that in admitting my dog(s) to the Center, Dogs On The Farm staff have relied on my representation that my dog(s) is/are in good health with no health restrictions on play unless otherwise disclosed to the Center and have not harmed or shown aggressive or threatening behavior towards any person or any other dog.   

I further understand and agree that Dogs On The Farm and their staff and volunteers, will not be liable for any problems which develop, provided reasonable care and precautions are followed, and I hereby release them of any liability of any kind whatsoever arising from my dog(s) attendance and participation at the Center.

I further understand and agree that any problems that develop with my dog(s) will be treated as deemed best by staff and volunteers of Dogs On The Farm, at their sole discretion, and that I assume full financial responsibility for any and all expenses involved.

I further understand that my dog (s) will be included in Dogs On The Farm’s PetAssurance Program, and I have read and understand the program and its inclusions and exclusions.  

I further certify that I have read and understand the policies of the Center as set forth on the preceding pages and that I have read and understand the conditions, and statements of this agreement, including the following:

Should any boarding animal become ill or seem to be in need of medical attention, we reserve the right to administer aid or use our veterinarian.  Any expenses so incurred, shall be paid by the owner of said animal in addition to other fees listed on this contract.

Daily boarding charges begin on the date entered on the current check in form.  Customer agrees to notify this kennel in advance if there is any change in the date boarding animal is to be picked up.  No boarding animal will be released until all charges are paid in full.

Owners shall remain liable for complete boarding as well as other charges incurred in the care, maintenance and disposal of said animal as listed on this contract.  It is expressly agreed by Owner and Kennel that Kennel’s liability shall in no event exceed the lesser of the current chattel value of a pet of the same species or sum of $200.00 per animal boarded.  The owner further agrees to be solely responsible for any and all acts or behavior of said pet while it is in the care of the Kennel.  The owner of the animal or his agent agrees to pay reasonable attorney’s fees incurred by the boarding facility in the collections of any boarding, grooming, or other charges incurred by the owner of the animal or his agent.

Dogs must be up to date on the following vaccinations:  Distemper, Bordetella, and Rabies.

Pets with fleas/ticks will be bathed/dipped at owner’s expense in order to maintain flea control in the kennel.

This kennel is not held responsible for the loss of any toys, leashes, collars, or bedding that is brought into the kennel.

 *
Dog Name (second dog - 2)
Dog Breed (2)
Sex (2)
Clear selection
Birthdate (2)
MM
/
DD
/
YYYY
Color (2)
Weight (2)
Brand of food (2):
Breakfast Instructions (2):
Dinner Instructions (2):
Snacks/Treats/Other (2):
If your dog isn't eating can he/she have an incentive (can food, chicken, peanut butter, cheese, etc?) (2):
Please list any medications, dosage/instructions, and reason for medications: (2)
Health issues(2):
Limitations on movement (hip dysplasia, arthritis, old injury, etc) (2):
Does your dog's activity need to be restricted in any way? (2)
Is your dog unusually heat sensitive? (outside play is limited when 'feels like' temperature is over 80 degrees and no outside play when 'feels like' temperature is over 85 degrees) (2)
Clear selection
Does your dog regularly cough or have diarrhea/vomiting? (2)
Does your dog regularly cough or have diarrhea/vomiting? (2)
Is your dog scared of any specific items or noises? (2)
Are there any people (like men, people wearing hats, etc) or dogs (breeds, sizes, etc) your dog fears or dislikes? (2)
Does your dog tend to jump or climb fences or escape yards? (2)
Clear selection
How would you describe your dog's personality? (2)
How would you describe your dog's energy level? (2)
Clear selection
Does your dog have any training? Do they know commands like sit / stay / come when called / loose leash walking? (2)
(If doing group play) How does your dog get along with other dogs? (2)
(If doing group play) How long have you had your dog? (2)
(If doing group play) If rescued, what do you know about your dog's history? (2)
(If doing group play) Why are you interested in group play for your dog? (2)
(If doing group play) Describe your dog's experience with group play, including any issues they have had(2):
(If doing group play) How does your dog react to a stranger coming in the house(2)?
(If doing group play) Does your dog bark at people/dogs outside your home(2)?
(If doing group play) How does your dog react to another dog approaching on leash(2)?
(If doing group play) Does your dog chase squirrels, bikes, etc(2)?
(If doing group play) Does your dog like puppies(2)?
(If doing group play) Does your dog mount/hump, jump on people, mouth, bark excessively, or have other problem behaviors(2)?
Please add any other notes you think might be helpful(2)?
Dog Name (third - 3)
Dog breed (3):
Sex (3):
Clear selection
Birthdate (3):
MM
/
DD
/
YYYY
Color (3):
Weight (3):
Brand of food (3):
Breakfast Instructions (3):
Dinner Instructions (3):
If your dog isn't eating can he/she have an incentive (can food, chicken, peanut butter, cheese, etc?) (3):
Please list any medications, dosage/instructions, and reason for medications: (3)
Health issues (3):
Limitations on movement (hip dysplasia, arthritis, old injury, etc) (3):
Does your dog's activity need to be restricted in any way? (3):
Is your dog unusually heat sensitive? (outside play is limited when 'feels like' temperatyre is over 80 degrees and no outside play when 'feels like' temperature is over 85 degrees) (3):
Clear selection
Does your dog regularly cough or have diarrhea/vomiting?(3):
Is your dog scared of any specific items or noises?(3):
Are there any people (like men, people wearing hats, etc) or dogs (breeds, sizes, etc) your dog fears or dislikes?(3):
Doesyour dog tend to jump or climb fences or escape yards?(3):
Clear selection
How would you describe your dog's personality?(3):
How would you describe your dog's energy level?(3):
Clear selection
Does your dog have any training? Do they know commans like sit / stay / come when called / loose leash walking?(3):
(If doing group play) How does your dog get along with other dogs?(3):
(If doing group play) How long have you had your dog?(3):
(If doing group play) If rescued, what do you know about your dog's history?(3):
(If doing group play) Why are you interested in group play for your dog?(3):
(If doing group play) Describe your dog's experience with group play, including any issues they have had?(3):
(If doing group play) How does your dog react to a stranger coming in the house?(3):
(If doing group play) Does you dog bark at people/dogs outside your house?(3):
(If doing group play) How does your dog react to another dog approaching on leash?(3):
(If doing group play) Does your dog chase squirrels, bikes, etc?(3):
(If doing group play) Does your dog like puppies?(3):
(If doing group play) Does your dog mount/hump, jump on people, mouth, bark excessively, or have any other problem behaviors?(3):
(If doing group play) Does your dog mount/hump, jump on people, mouth, bark excessively, or have any other problem behaviors?(3):
(If doing group play) Please add any other notes you think might be helpful(3):
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