Pooch Play Application

Name

Address    City  Zip

Phone Home Cell Work Other  Phone  Home Cell Work Other

Phone Home Cell Work Other   Phone  Home Cell Work Other

Email

Emergency Contact Person    Phone

Dog's Name Breed  Sex  Male Female DOB 

Name of Groomer      Phone 

Name of Vet      Phone 

Vaccination Dates: Rabies  DHLP  Rabies  Bordatella 

List Medical Conditions

Fears  Yes No    Describe

Allergies Yes No    Describe

Flea Prevention  Yes No Brand

Has Your Pooch Ever Shown Food / People / Territory / Animal Aggression? Yes No

If yes, describe in detail 

King County License# Microchip# Brand

How did you hear of our services

Please check the following, acknowledging that you have read and understand.....

1.All pooches must be up to date on their vaccinations including bordatella.  Bordatella is recommended
    every 6 months for dogs that are in social gatherings.

2.A flea program is recommended.  We can not be held responsible if your dog contracts fleas.

3.All pooches must be clear of all contagious diseases or illness at least 15 days prior to attending play group. 

4.All females must be spayed at least 15 days prior to attending play group.  Unaltered males may
    attend with the proper temperament.

5.All pooches must be a minimum of 4 months old.

6.All pooches must have an initial evaluation prior to attending play group.  This does not guarantee
    that your pooch will not demonstrate different behaviors while attending play group.

7.All pooches must be non aggressive towards other dogs, people, toys, and food.

8.All pooches able to climb / jump / or escape over a five foot fence will not be permitted to attend play group.

9.A current application must be on file at all times.

10.Payment for play group must be made in advance of play dates.

11.Short notice cancellation may result in loss of payment for that day.

12.Pooch Play will be closed on all state government recognized holidays.

13.Full refund or credit will be given in the event that a Pooch Play date is cancelled.

14.A bank charge of $25 will be applied to all returned checks.

15.We reserve the right to dismiss any dog from Pooch Play should they show aggressive or
    threatening behavior at any time.

16.The safety and health of all dogs participating in Pooch Play is the primary concern.

17.This agreement shall be binding from the present date and all future dates of service.

18.I understand that dogs are not always predictable and that interactive dog play is not without some risk of injury.

19.I agree to pay for all veterinarian or medical expenses incurred as a result of injury to or caused by my dog.

20.I further understand that with all due diligence and care having been exercised, that all pets are handled
    without liability on the part of Tracy Skylstad, employees, volunteers, or anyone handling on the behalf
    of Tracy's Pet Services for loss or damage from disease, death, running away, theft, fire, injury to
    person, other animals, or property by my dog, or other unavoidable causes, including natural disasters.

21.I certify that I have answered all questions truthfully and to the best of my knowledge.  I also state that I am the owner, or the agent of the owner, of the above named dog and have read and agree to the conditions noted.

Type Name Here   Date