REGISTRATION FORM

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HUMAN INFORMATION

Home Address __________________________________________________________

City ____________________________ State __________ Zip __________________

Home Phone (     ) ___________Work Phone (     ) ____________________

Cell Phone (     ) _____________Pager (     ) _________________________

E-Mail Address _____________________________________________________

CA Driver's License# _________________________________________

Veterinarian _____________________________  Phone (           ) _________________

Pet Insurance _______________________________________________


Who should we call to pick up your dog(s) if you are not available?

Name ____________________________ Phone (           ) ___________________

How did you hear about Doggie Central? __________________________________  

DOGGIE INFORMATION

#1 NAME ___________________________ Breed ____________________________

Vaccination Dates:  DHLPP ______________    Rabies ______________   
Bordetella ____________

Medical Problems/Meds ______________________ Flea Product _______________

Behavior Problems ________________ Aggression w/ People or Dogs_________

Jump fences/escape enclosures? Explain: ___________________________________________________

#2 NAME ___________________________ Breed ____________________________

Vaccination Dates:  DHLPP ______________    Rabies ______________   
Bordetella ____________

Medical Problems/Meds ______________________ Flea Product _______________

Behavior Problems ________________ Aggression w/ People or Dogs_________

Jump fences/escape enclosures? Explain: ___________________________________________________

Has (have) your dog(s) ever been to Doggie Daycare before? ____
Overnight? ___ Dog Parks ______

________________________________________________

COLLARS/ID TAGS
 
For your pet’s protection, NO choke chains or prong collars are allowed in the play areas!  Your dog must be wearing a buckle type collar with proper identification in case of any emergency situation.
 
PAYMENT TERMS
 
Payment is due at the time of pickup.

We accept credit cards (MasterCard or Visa), cashier’s checks, money orders, and cash.

It is the responsibility of the owner to keep dogs updated on all vaccinations and flea treatments. If a dog is found to have fleas at any time, he/she will be given a bath and flea treatment at the owner's expense. If updated vaccination records are not provided to the front office, and attempts at gathering the pertinent information do not result in confirmation of current vaccinations, we must administer the vaccinations at the owner's expense.

Any dog left for an extended period of time (to be determined by the owner of Doggie Central) without payment will be placed in an appropriate home.
 
DROP-OFF/PICK-UP HOURS
 
Doggie Central is a 24-hour care facility.  However, our regular drop-off and pick-up hours are Monday through Saturday, 6:30 a.m. to 9 p.m., and Sunday, 7:30 a.m. to 9 p.m.  Prior approval is required for any non-regular arrangement.  There is a $10.00 charge for non-regular drop-offs and a $25.00 charge for non-regular pick-ups!  For the benefit of the dogs that are sleeping here, extra early drop-offs must be dropped off the night before, and extra late pick-ups must be picked up the next morning.
 
AGREEMENT
 
I understand and agree that in admitting my dog(s) to Doggie Central, that Doggie Central has relied on my representation that my dog(s) is/are in good health and has/have not harmed or shown aggressive or threatening behavior towards any person or any other dog.

I further understand that I am solely responsible for and agree to indemnify Doggie Central from all liability incurred as a result of any injury and/or harm to a person or another dog caused by my dog(s) while visiting Doggie Central.

I further understand and agree that Doggie Central and their staff and volunteers will not be liable for any problems that develop provided reasonable care and precautions are followed, and I hereby agree to release them and hold them harmless from any liability of any kind whatsoever arising from my dog(s) visitation and participation at Doggie Central.

I further understand and agree that any illness that my dog(s) develop(s) while visiting Doggie Central will be treated as deemed best by staff and volunteers of Doggie Central and in their sole discretion, and that I assume full financial responsibility for any and all expenses involved.
 
I certify that I have read and understand the payment terms, rules and agreement.  I agree to abide by the rules and accept all the terms, conditions, and statements of this agreement.
 
 
Owner’s Signature _____________________________ Date ___________
 
I further understand and agree that my dog may be injured or may cause injury to another dog.  I give my full authorization to use my credit card for these purposes if deemed necessary.
 
Credit Card #_________________________________ Exp. Date ______________
 
 
Type of Card _________ Signature ________________________________________