Daycare Registration Form

Owner Name *
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone * - (###) - ### ####
Cell Phone - (###) - ### ####
Work Phone - (###) - ### ####
Other Phone - (###) - ### ####
Email *
Dog Name *
Breed or Breed Mix *

Enter Breed or Breed Mix
Age *
My dog is... * Male Female
My dog has... * Not been spayed or neutered Been spayed or neutered
Vaccination Information:

-Rabies Vaccine Needed at least once within your dog's lifetime
-Parvo/Distemper Combo Needed within 3 years prior to attending daycare
-Bordetella/Kennel Cough vaccine must be updated every 12 months
Date of Last Bordetella/Kennel Cough Vaccination (Important Note: This vaccine cannot be given within 5 days of the start of your dog's first day at daycare. Your dog needs 5-7 days to build an immunity and may become a carrier of the disease immediately after the vaccination. Please leave plenty of time to update your bordetella vaccine before starting daycare.) * / MM / DD YYYY
Date of Last Parvo/Distemper Vaccination or date of last Titer Test (This vaccine is valid for 3 years after your dog receives it.) * / MM / DD YYYY
Date of Last Rabies Vaccination * / MM / DD YYYY
Veterinarian Name * First Last
Veterinarian Phone Number * - (###) - ### ####
My Dog can Climb or Jump Over a Six Foot High Chain Link Fence * Yes No Unknown
My Dog Plays Best With (Check All that Apply): * Big Dogs Small Dogs Quiet Dogs Active Dogs All Dogs Needs Help Learning to Play with Dogs, but is Not Aggressive
My Dog Needs a Lunch or a Nap While in Daycare? * Yes No
My Dog Can Be Possessive of Toys with People? * Yes No
My Dog Can Be Possessive of Toys with Other Dogs? * Yes No
My Dog (Check All that Apply): * Has Been to Daycare Before Has Been to Dog Parks Before Has Never Been to Daycare Has Never Been to a Dog Park Plays Well With Other Dogs Can Sometimes Be Grumpy with Dogs Has Been in Fights with Other Dogs Before
These People Are Also Authorized to Pick up My Dog in My Absence: First Last
First Last
How Did You Hear About Canine Harmony Dog Daycare? * Referral from a Friend Pet Store Dog Park Driving By Internet
I understand that attendance at a dog daycare is not without risk to my dog, because some of the dogs to which my dog will be exposed may be the cause of injury even when handled with the greatest amount of care.

I hereby waive and release CANINE HARMONY DOG TRAINING ACADEMY hereinafter referred to as the Training Organization, its employees, officers, members, and agents from any and all liability of any nature, for injury or damage which my dog may obtain, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while my dog attends dog daycare, or while on the training grounds or the surrounding area thereto.

In consideration of and as inducement to the acceptance of my application for Dog Daycare by this Training Organization, I hereby agree to indemnify and hold harmless this Training Organization, its employees, officers, members, and agents from any and all unavoidable accidents, while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own, as well as any accident which may occur while on the training grounds or surrounding area. * I agree that dog daycare is not without risk and I am aware of these risks.
For sanitary purposes, all our play yard surfaces are pea gravel. This allows us to bleach and disinfect the yard several times per week to protect the health and safety of your dog(s). Some dogs, however, are not used to this surface and may develop sore feet during their stay. Canine Harmony will check my dog's feet daily to check for any irritation and will apply any necessary creams or ointments to my dog's feet should they become red or sore and will protect my dog's feet from further irritation. * My dog is mostly an inside dog and does not walk on hard surfaces on a regular basis. My dog probably has sensitive feet and will need rests during the day to protect his/her feet from becoming red or irritated. By checking this box, I agree to release Canine Harmony of any liability should my dog's feet become red or irritated. My dog goes out regularly, but usually on grass or smooth pavement. My dog may have sensitive feet and may require rests during the day to protect his/her feet from becoming red or irritated. By checking this box, I agree to release Canine Harmony of any liability should my dog's feet become red or irritated. My dog goes out regularly and has been exposed too many different surfaces like sand or gravel. My dog probably does NOT have sensitive feet and should be fine to play during regular play time. However, by checking this box, I agree to release Canine Harmony of any liability should my dog's feet become red or irritated.
My dog has not been exposed to rabies, parvo, distemper, bordetella or any other contagious disease in the past 30 days. * By checking this box I agree to the previous statement regarding my dog's previous exposure to disease.
Canine Harmony agrees to provide daycare for and provide all physical and emotional care of the above mentioned dog(s) while on its premises. Canine Harmony Dog Training Academy agrees that, while the dog(s) is/are on the premises and under its control for daycare, The Academy will exercise the utmost diligence and care to protect the health and safety of your dog(s). However, the owner of the dog(s) agrees that Canine Harmony Dog Training Academy has no liability for loss or damage to the dog or the owners property resulting from fire, natural disaster or other unavoidable acts of nature. * By checking this box I agree to the previous statement regarding the welfare of my dog in the care of Canine Harmony.
In case of accident, injury or other medical problem, I allow Canine Harmony to administer any treatment necessary to protect the health and safety of my dog while on the premises. * By checking this box I agree to the previous statement regarding the care of my dog at Canine Harmony.
Dogs may be energetic and wrestle or jump on each other while in daycare. Your dog may get a scratch from time to time if they play with other energetic dogs. Some breeds that are more prone to scratches are dogs with very short hair and little undercoat such as boxers, bulldogs, dobermans and doodles with short hair cuts. All employees at Canine Harmony are certified in Canine First Aid and any scratches will be checked, treated and monitored as needed. Vet care is typically not necessary for a minor scratch. * I am aware that my dog may get an occasional surface scratch and I allow Canine Hamrony to treat scratches as needed.
In case of accident, injury or other medical problem to my dog(s) that Canine Harmony is unable to treat on the premises, I authorize Canine Harmony to take my dog to my own vet or any other available vet including an Emergency Veterinarian (if it is after hours) to obtain the necessary treatment required for the health and safety of my dog. Canine Harmony will attempt to contact me, but if I am unable to be contacted, necessary vet care will be provided without my permission. * 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.
If, at the end of the daycare day the dog is not picked up by the owner Canine Harmony Dog Training Academy shall try to contact the owner. If Canine Harmony is unable to contact the owner by 7pm, the dog will be boarded overnight and fed a good quality dry food for any meals required while in our care. If, at the completion of the boarding time, the dog is not picked up by the owner and payment of all charges made in full, including applicable medical, veterinarian, food or boarding charges as provided herein, Canine Harmony Dog Training Academy shall notify owner by certified mail at the address shown above that the dog will be held for an additional five (5) business days following the date of mailing the notice. At the end of the five (5) day period, if there is no response from the owner, the dog may be sold at public or private sale. The proceeds from such sale shall first be applied to the charges of Canine Harmony Dog Training Academy and the balance, if any, shall be returned to the owner at the address shown above. Owner shall be charged for any additional days following notice at Canine Harmony Dog Training Academy at the current daily boarding rate.
* 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.
Owner represents that he or she is the legal owner of the dog(s); that the dog(s) is/are free and clear of any mortgage or encumbrance; that the dog(s) has/have been vaccinated as shown above and that the owner has read this agreement in its entirety. 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.

Daycare Registration Form

Daycare Registration Form

Vaccination Information: -Rabies Vaccine Needed at least once within your dog's lifetime -Parvo/Distemper Combo Needed within 3 years prior to attending daycare -Bordetella/Kennel Cough vaccine must be updated every 12 months

Vaccination Information:

-Rabies Vaccine Needed at least once within your dog's lifetime
-Parvo/Distemper Combo Needed within 3 years prior to attending daycare
-Bordetella/Kennel Cough vaccine must be updated every 12 months