Daycare Registration Form

OWNER INFORMATION

First Name:

Enter your Last Name please

Last Name:

Enter your Last Name please

Street Address:

Enter your street address such as 17778 24th Ave

Address Line 2:

Enter your extra street address info

City:

Enter your city you live in

Provience/State:

Enter your Province or State you live in

Postal Code:

Enter your postal you live in

Country

Enter the Country you live in.

Primary Phone:

Please enter your Primary Phone number.

Secondary Phone:

Please enter another phone number we can contact you at.

Email Address:

Enter your email address we can contact you through.

DOG INFORMATION

Dog's Name:

Enter the name for your dog.

Breed:

What Breed is your dog?

Age:

Enter how old your dog is in years

My Dog is ...

Please indicate if your dog is a male or female.

My Dog is spayed or neutered

Check if your dog is spayed or neutered

Select date of Last Bordetella/Kennel Cough Vaccination

Please read the ? on the right hand side for more information

Select date of Last Parvo/Distemper Vaccination

Read ? at right side for more information

Select date of Rabies Vaccination:

Date of Last Rabies Vaccination

My Dog..

Read the ? for more information on which option to choose.

VETERINARIAN INFORMATION

Name:

Veterinarian Name or Office Name

Primary Phone:

Most direct phone number to the vet or vet's office.

CHECK ALL THAT APPLIES TO YOUR DOG

Needs a Nap/Rest While in Daycare

Needs a meal while in Daycare

Got Lunch?

Can Be Possessive of Toys with People

Can people play with your toys?

Can Be Possessive of Toys with Other Dogs

Can Rover play with your toy too?

Has Been to Daycare Before

Has Been to Daycare Before?

Has Been to Dog Parks Before

Dog Parks?

Plays Well With Other Dogs

You dog plays well with others?

Can Sometimes Be Grumpy with Dogs

Got a grump?

Has Been in Fights with Other Dogs Before

Meet at the bike racks?

THESE PEOPLE ARE AUTHORIZED TO PICK UP MY DOG IN MY ABSENCE OR IN CASE OF EMERGENCY

First Name (Person 1):

First name of the first person

Last Name (Person 1):

Last Name of First Person

Phone (Person 1):

Enter the First Person's Primary Phone Number

First Name (Person 2):

First Name of the second person

Last Name (Person 2):

Last name of the second person

Phone (Person 2):

Phone number for the second person

OTHER INFORMATION AND LEGAL NOTICES

POINT OR CLICK ON THE ? ON THE RIGHT SIDE OF THIS FORM TO READ EACH WAVIER.
ALL WAIVERS MUST BE ACCEPTED TO SUBMIT FORM.

How did you hear about us:

Please select how you heard about us.

I agree that dog daycare is not without risk and I am aware of these risks

Read ? at Right side of page (-->) for risk wavier.

My dog has not been exposed to rabies, parvo, distemper, bordetella or any other contagious disease in the past 30 days.

Has your dog been sick lately?

I agree to the statement regarding the welfare of my dog in the care of Canine Harmony

PLEASE READ THE ? ON RIGHT SIDE FOR FULL WAIVER INFORMATION

I agree to the statement regarding the care of my dog at Canine Harmony

I am aware that my dog may get an occasional surface scratch and I allow Canine Hamrony to treat scratches as needed

By checking this box, I agree to pay all vet bills that my dog incurs while under the care of Canine Harmony and any other costs associated with said vet visit including travel time to a vet over 30km away (at a rate of 40 cents per km) if no vet nearby is available or I choose to use my own vet which is located out of the area

By checking this box I agree that I will pick up my dog after daycare or will notify Canine Harmony and agree to pay all additional charges if I am unexpectedly delayed

I have read and undertand this document in its entirety and agree to all the previous statements regarding my dog's stay at Canine Harmony

Enter the code

ENTER THE BLACK LETTERS ONLY. CASE SENSITIVE

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