DayCamp Registration Form - Grace Park Animal Hospital

Name *

First

Last

Mobile Number *

Pet's Name *

Pet's Age *

Gender *

Spayed Female
Female
Neutered Male
Male

Breed *

Color *

Has your dog ever been to another Daycamp or boarding facility? *

Why are you bringing your dog to Daycamp? *

Is there any person, type of dog, or situation that makes your dog uncomfortable? *

Has your dog ever growled at or bitten a person or dog? *

Can you take food and/or toys away from your dog without him/her growling?

Will your dog share toys with other dogs?

Has your dog ever jumped a fence or other barrier? *

Are there any areas on your dog’s body where he/she does NOT like to be touched? *

Has your dog ever socialized with a group of 4 or more dogs before? *

What size dog(s) does your pet enjoy playing with (i.e., small medium, large, xl)?

What style of play/energy level does your pet enjoy (i.e., relaxed sunbathing with friends, light socialization, rough and tumble play)?

Are there any restrictions that should be placed on your dog’s activity? *

Does your dog have any allergies or other medical conditions? *

Is your dog responsive to commands? If so, what commands do you use? *

Is there anything else you would like to tell us about your dog?

Acknowledgement of Daycamp Policies, Procedures, and Release Agreement

Submission of this form indicates your understanding and agreement to the following policies:

Daycamper Requirements

Dogs participating in daycamp must be in good general health, free of fleas and ticks, and must be spayed or neutered if over 6 months of age. To prevent the spread of infectious diseases, all patients staying in the hospital must be current on the following vaccines: rabies, distemper, canine influenza and bordetella and free from internal parasites (annual fecal examination required).

Aggressive Dogs

I understand that if my dog acts aggressively or shows unacceptable behaviors, he/she may be separated from the DayCamp group and be given individual play time based upon staff discretion. I understand that a Grace Park Animal staff member will consult with me on ways to address any behavioral issues that may arise. Aggressive dogs may be asked not to return to DayCamp and alternative options will be explored. Photographs: I am aware that photographs taken of my dog participating in DayCamp may be posted to the Grace Park Animal Hospital website and/or Facebook page.

Photographs

I am aware that photographs taken of my dog participating in DayCamp may be posted to the Grace Park Animal Hospital website and/or Facebook page.

Duty to Disclose

I have disclosed and will continue to disclose in the future any and all medical or other conditions, including personality issues or concerns that may affect my dog’s ability to participate in DayCamp.

Acceptance and Acknowledgement of DayCamp Participation Risk

I understand that there are inherent and potential risks involved with interactions between humans and dogs, as well as between dogs and other dogs. These interactions could result in injury and I understand that Grace Park Animal Hospital will take appropriate medical action in such situations to ensure the safety and well-being of persons or dogs involved. I fully accept and assume responsibility for all risks as a result of my dog’s participation in DayCamp.

Signature *

Clear Signature

Signed by (type name): *

Date Signed *

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