Doggy Daycare Registration

Owner’s Name: _____________________________________________________________

Address: ___________________________________________________________________

Phone: (home) ________________________ (work) _______________________________

Email address: ______________________________________________________________

Alternate Emergency Contact: ________________________________________________

Name: _______________________________________ Phone: _______________________

Dog’s Name: ________________________________________________________________

Age: ___________________________________ Birthdate: __________________________

Sex: ___________ Breed: _____________________________________________________

Neutered/Spayed: ____________________________________________________________

Referred By: _________________________________________________________________

Veterinarian: Name _________________________________ Phone ___________________

• Your dog must be current on Distemper, Bordetella and Rabies vaccinations, be on a flea preventative program, and be free of parasites to attend our Doggy Daycare. We will need to see documentation for your vet regarding these requirements.

• Your dog’s attendance at Doggy Daycare is not without risk. Every effort will be made by the Mad City Dog training staff to provide a safe environment for your dog. If your dog requires emergency medical attention, we will contact you immediately and transport your dog to the Emergency Clinic for Animals.

• You are responsible for any damage or injury incurred while your dog is at Daycare. Vet charges due to injury to your dog or injury to another dog caused by your dog will be the responsibility of you and the owner of the other dog.

• Bitches in season will not be able to attend Daycare.

• Your dog’s acceptance into your Daycare is the sole discretion of the Mad City Dog Training staff. If your dog is disruptive while at the Daycare, he/she will not be able to return to Daycare until the problem is resolved.

I, the undersigned, agree to the above, accept full responsibility for the acts of my dog while at Daycare and release Mad City Dog Training, LLC, and its staff from any and all claims of liability.

Signature ____________________________________________________ Date ____________________

Print this form, complete, sign and bring it with you to your doggy daycare evaluation.