Daycare/Boarding/Grooming Application

Client Information:

(Fields marked in red with an * are required)

First*:
Last*:
MI:
Address*:
City*:
State*:
Zip*:
Cell:
Work:
Home:
Email address*:
Fax#:

Clinic Information:

Vet/Clinic*:
Phone*:
Fax:
Address*:
City*:
State*:
Zip*:
Check all boxes that apply:
Daycare
Boarding
Grooming
Training

Emergency contact (other than your veterinarian or yourself):

Name:
Phone:
Relationship:
Name(s) of people authorized to pick up your dog(s):
How did you hear about us?

Dog(s) Information:

Dog #1 Name (s)*
(DOB)*
M F
Breed*:
Color*:
Weight*:
Spay/Neuter*:
Yes No

Shot record dates*:

Bordatella*:
Distemper*:
Rabies*:
Yearly Heartworm test*:
Yes No
If yes, what brand of preventative
Flea and Tick Medication*:
Yes No If yes, what brand of preventative
Microchip:
Yes No
Chip #
Please list any medical conditions*:
Medication(s)*:

Dog #2 Name (s)*
(DOB)*
M F
Breed*:
Color*:
Weight*:
Spay/Neuter*:
Yes No

Shot record dates*:

Bordatella*:
Distemper*:
Rabies*:
Yearly Heartworm test*:
Yes No
If yes, what brand of preventative
Flea and Tick Medication*:
Yes No If yes, what brand of preventative
Microchip:
Yes No
Chip #
Please list any medical conditions*:
Medication(s)*:

Dog #3 Name (s)*
(DOB)*
M F
Breed*:
Color*:
Weight*:
Spay/Neuter*:
Yes No

Shot record dates*:

Bordatella*:
Distemper*:
Rabies*:
Yearly Heartworm test*:
Yes No
If yes, what brand of preventative
Flea and Tick Medication*:
Yes No If yes, what brand of preventative
Microchip:
Yes No
Chip #
Please list any medical conditions*:
Medication(s)*:

For your convenience you may have your Vet. fax your dog(s) records to us. Fax # (205) 458-9365


Services interested in:

1. Has your dog ever escaped or attempted to?
Dog #1
Dog #2
Dog #3
2. Has your dog been enrolled in daycare before?
Dog #1
Dog #2
Dog #3
3. Is your dog toy/food possessive?
Dog #1
Dog #2
Dog #3
4. Has your dog ever shown aggression toward a person or other dog?
Dog #1
Dog #2
Dog #3
7. Has your dog ever bitten someone or another dog?
Dog #1
Dog #2
Dog #3
8. Has your dog ever reacted negatively to strangers?
Dog #1
Dog #2
Dog #3
9. Does your dog have food or other allergies
Dog #1
Dog #2
Dog #3
10. Does your dog have a circumstance that he/she is frightened of?
Dog #1
Dog #2
Dog #3
11. Does your dog have any medical restrictions on his/her activity?
Dog #1
Dog #2
Dog #3
12. Does your dog receive regular exercise?
Dog #1
Dog #2
Dog #3
13. Does your dog have any problem being crated?
Dog #1
Dog #2
Dog #3
14. Does your dog have accidents in the house?
Dog #1
Dog #2
Dog #3
15. Does your dog have any area on his/her body that should not be touched?
Dog #1
Dog #2
Dog #3

Please comment on any items which are checked above:

This info is for Daycare and Boarding dogs Only!!!

Note: Always be sure to check your dog(s) cubby for updates and reports on Daycare/Boarding You will be provided medication and food feeding schedule forms Board¬ing. Thank you for allowing us to care for your BFF! We promise to treat your dog like one of our own with plenty of belly rubs, hugs, kisses, and scratches behind the ears!

Signed:
Date:

Dog Days of Birmingham --- Temperament Test


Temperament Test Explained: A temperament test is a series of planned exercises designed to assess the new dogs potential for aggressive behavior while determining the current level of social development to ensure that it is not aggressive and can play well with others, without posing a danger to itself or others.

Temperament Test Clients: Interview Clients should arrive on the day of their temperament test with all the applications and waivers complete and an up to date record on vaccinations. After arriving, a daycare representative will sit down with you and your dog and discuss the information that you have provided in the application package. Immediately following this discussion, you will be asked to leave or wait for a short period of time while the actual test is performed.

The temperament test process: Our daycare has a small group of "facility dogs" that are well known and their behavior is consistent and that we trust. We have experience with these dogs and we can control them at the drop of a hat. These dogs are best friends of the facility and some are owned by the owners of our daycare. We will place your dog in a secure area, a temperament testing area that is ideally designed for this process. While keeping your dog on a leash, we will allow the dog to meet and greet each human member of our staff that works at the facility. The greetings will be observed for fearful or aggressive behaviors toward the staff. Once this is complete, we will bring in the first facility dog on a leash. The first dog will be a very mild mannered dog and the meeting process wil be observed for threatening body language, or posturing, and if no negative behavior presents itself then we will unleash the new dog while remaining very close in case problems arise. If all goes well we will then introduce a toy into the environment and initiate play and observe for possessive/aggressive tendencies. This will be monitored for about 10 minutes. If all goes well we will then bring in another stock dog and start the entire process over observing the new dog for any stress brought on by the new facility dog. Once we have introduced the facility dogs to the new dog's test and observed each for 10 minutes we should begin to see play behavior, or even casual disinterest by the new dog after he/she becomes accustomed to the play pack we have created.

If all of the previous testing has gone well it is now time to introduce the new dog to the main pack, which is a fairly simple process and one that does not need a lot of fanfare. The new dog, while on leash, will be walked into the main pack. This will happen while the main pack is under complete control. There will be lots of sniffing, tail wagging, and some posturing from some of the senior members of the pack and this is totally normal and to be expected. If any members of the pack begin to seem a little pushy, the handler will insure to the pack that the new dog is "with you" and that you control the situation. After 5 to 10 minutes the newness will ware off and the pack will return to it's normal activities and the new dog will become more of "just another dog". This is now the proper time to release the new dog from the leash and allow them to venture out a bit on their own. The new dog will likely join the group and introduce themselves. The handler will remain as a shadow observing the process up close. A few of the more senior members may not like the excitement of the new dog and react a little negatively. This also is to be expected and they are just telling the new dog to calm down.

Again, after 5 to 10 minutes this should subside also. If this is how the entire process happened, then congratulations. Your beloved dog is now being accepted into daycare and has found their new pack or friends.


Dog Days of Birmingham's Client Agreement

REQUIRED

I request that my dog(s) be accepted into the Dog Days of Birmingham, boarding or other programs offered by this Dog Days of Birmingham facility (the "Facility"). In accepting my dog(s) into the programs, I acknowledge that the Facility will be relying on my understanding and agreement with the provisions of this Agreement.

I understand and agree that (read and initial each box below):

Dog Days of Birmingham, LLC (Herein after referred to as Dog Days of Birmingham) and its members, officers, directors, managers, employees, contractors, and agents will not be liable for problems, damages, or injuries caused by my pet during its visit at Dog Days of Birmingham.

I, as the pet owner (or as the pets authorized agent), agree to be solely responsible for any and all acts or behavior of my pet while in the care of Dog Days of Birmingham. I hereby release and agree to indemnify and hold harmless Dog Days of Birmingham from any liability arising from my dog's attendance and participation in any Dog Days of Birmingham's daycare and/or play sessions.

Every dog reacts differently and animals, by nature, are unpredictable and, therefore, present a certain level of risk. I acknowledge and understand that there are certain risks involved in participating in day care or boarding and in owning, training, caring for, handling and being in the presence of dogs, including but not limited to injuries to people, property and animals resulting from dog fights, dog bites to humans or other dogs and the transmission of disease. I hereby accept those risks, for myself and for my dog and agree that Dog Days of Birmingham shall not be held responsible for any injuries suffered

In case of emergency, I recognize the risks of injury that accompany said transport and acknowledge that this Agreement is being relied upon by this Facility to permit transport of my dog to and from the Facility or any other necessary location. I accept any and all conditions, rules and regulations promulgated by this Facility associated with the activities, use of the facilities and transport, and hereby agree to comply with them and I hereby accept those risks, for myself and for my dog and agree that Dog Days of Birmingham shall not be held responsible for any injuries suffered by myself or my dog as a result of any such incidents at Dog Days of Birmingham.

Dogs not regularly exposed to the level of activity at the Facility may feel the discomfort of sore muscles, sore joints and fatigue, and dogs not regularly exposed to outside activity or play on hard surfaces may experience sore paws, blisters, bruises or abrasions on the feet (Raw Paw). I hereby accept those risks, for myself and for my dog and agree that Dog Days of Birmingham shall not be held responsible for any injuries suffered by myself or my dog as a result of any such incidents at Dog Days of Birmingham.

Dogs not regularly socialized do not necessarily know how to behave politely with other dogs. These dogs are at higher risk of incidents including, but not limited to, bites, fights, fear aggression, object guarding, behavior problems and/or acting out. I hereby accept those risks, for myself and for my dog and agree that Dog Days of Birmingham shall not be held responsible for any injuries suffered by myself or my dog as a result of any such incidents at Dog Days of Birmingham.

Dogs at play during the regular day care get dirty. Dogs with longer hair can get matted from the level of activity at day care. I hereby accept and assume those risks, for myself and for my dog and agree that Dog Days of Birmingham shall not be held responsible for any such incidents at Dog Days of Birmingham.

Baths and brush outs can be requested and scheduled at my expense.

Excessively long toenails may cause injury. I will be notified if my dog's nails are too long. If, at my next visit, the nails have not been trimmed, the Facility will have them trimmed at my expense. I hereby accept those risks, for myself and for my dog and agree that Dog Days of Birmingham shall not be held responsible for any injuries suffered by myself or my dog as a result of any such incidents at Dog Days of Birmingham.

There are extra risks to my puppy of contracting disease or illness by entering the day care or boarding program without being fully vaccinated. I hereby accept those risks, for myself and for my dog and agree that Dog Days of Birmingham shall not be held responsible for any injuries suffered by myself or my dog as a result of any such incidents at Dog Days of Birmingham.

Water is available at all times; however, my dog may still be thirsty after day care. I will be aware of their water intake as excessive amounts may cause an upset stomach or other problems. I hereby accept those risks, for myself and for my dog and agree that Dog Days of Birmingham shall not be held responsible for any injuries suffered by myself or my dog as a result of any such incidents at Dog Days of Birmingham.

Dramatic changes in food and/or food quality may cause upset stomachs, diarrhea, and/or colitis. I hereby accept those risks, for myself and for my dog and agree that Dog Days of Birmingham shall not be held responsible for any injuries suffered by myself or my dog as a result of any such incidents at Dog Days of Birmingham.

I understand that the risks of injury listed above are exemplary and that there may be other risks of injury not listed here that may be faced by myself or my dog. I hereby accept those risks, for myself and for my dog and agree that Dog Days of Birmingham shall not be held responsible for any injuries suffered by myself or my dog as a result of any such incidents at Dog Days of Birmingham.

In understand and agree that any behavior deemed dangerous or inappropriate by Facility personnel may result in dismissal of my dog(s) from the programs.

I must pay for all services at the time they are rendered. I understand any unpaid fees by me will be sent to collections, and I will be responsible for all collections and legal fees incurred by such actions taken.

In admitting my dog(s) into the Facility, the Facility has relied on my representation that my dog(s) is/are in good health, has/have not been ill with any communicable disease within the last 30 days and has/have not harmed or shown aggressive or threatening behavior towards any person or any other dog.

I have read and understand the Facility's "Rules and Regulations."

I understand that Facility staff gives all pets involved in any type of incident a cursory examination; however, the Facility's staff is not trained veterinarians and will not be liable for the location, treatment or diagnosis of any injuries incurred on the Facility's premises. If my dog(s) is/are involved in an incident at the Facility, I will check my dog(s) further or seek treatment for my dog(s) by a licensed veterinarian at my discretion and cost.

Photographs, videotape or digital recordings are taken of the facility, dogs, customers and staff on a regular basis for, among other things, use in advertising by Dog Days of Birmingham. I acknowledge that all such images (electronic, negatives and positives), together with prints and the copyrights therein, are the property of Dog Days. I give Dog Days and persons authorized by Dog Days my consent, permission and authorization, without compensation to me, to use, reproduce and alter the images, in print or electronic format (including on the internet), either alone or in combination with other images, text and graphics. I waive my right to approve the finished photograph, advertising copy, print material or electronic files that may be used in conjunction with the images.
I grant the Facility and/or its agent's full power of decision concerning the care and well being of my dog(s) while at Dog Days of Birmingham. Should any medical emergency arise, it is agreed that the Facility or its selected agents can and will make any needed decision concerning medical treatment and choice of care giver up to $ and I will be responsible for reimbursing all such costs to the Facility.

I represent that I am at least 19 years of age and, in all respects, legally able to, and do hereby, make the foregoing agreements and acknowledge that the rights and responsibilities contained herein are binding on myself, my heirs, successors and assigns.

Signature:
Date: