Registration Form

Registration Form

Thank you for booking your dog(s) in for their induction with us here at the Mansfield Doggy Day Care Centre. Please can you complete the following information prior to your appointment with us.

Please complete one form per dog if you are registering multiple dogs.

What is your dogs name?

What sex is your dog?

What is your dogs breed?

What is your dogs colour?

How old is your dog?

What is your dogs date of birth?

Is your dog spayed / neutered?

Is your dog microchipped? (If so please state chip number)

If your dog is a bitch and not spayed, when was their last season?

Veterinary Practice Information

What is the name of your veterinary Practice?

What is their address?

Address Line 1

Address Line 2

Postcode

What is their phone number?

Dogs Medical Health

Has your dog had the kennel cough vaccine? (If so what was the date received and the date isn’t next due?) *Please note that this vaccination isn’t required for registration however is recommended

Has your dog has its standard vaccinations? (If so what was the date received and the date its next due?)

Has your dog had their flea and worming treatments? (If so what was the date received and the date its next due?)

Does your dog have any medical conditions? (If so please specify)

Has your dog had any recent / current injuries? (If so please specify)

Is your dog currently on any medication? (If so please specify)

Does your dog have any allergies or food sensitivities? (If so please specify)

Please note we cannot be responsible for any accident or injury as a result of undeclared information

Dogs Behaviour

Has your dog ever reacted negatively around food, shown aggression to anybody or another dog or bitten anybody or another dog? (If so please detail)

Owner Information

Title (Mr/Mrs/Ms/etc):

First Name

Last Name

Address

Address Line 1

Address Line 2

City

Postcode

Home Phone Number

Mobile Phone Number

Work Phone Number

Emergency Contact (If urgent contact is required and your not available)

Title (Mr/Mrs/Ms/etc):

First Name

Last Name

Home Phone Number

Mobile Phone Number

Work Phone Number

How did you hear about us?

Word of mouth

Leaflet

Vet

Facebook

Instagram

Search Engine

Newspaper

Other

Pet Services

Have you used a doggy day care before?

Yes

Have you used a groomer before?

Yes

Has your dog ever had a bad experience with any of the above services? (If so please detail)

Food

Are you happy for your dog to receive healthy treats at the centre?

Will your dog be due a meal at day care? If YES what time (Please note this will need to be provided by yourself)

Day Care

How often on average will your dog be visiting the centre?

Daily

Weekly

Monthly

Preferred Days

What services are you interested in?

Full Day

Half Day

Stay & Play

Dog Walks

Would you be using our dog taxi service for our full day care service? If so we will require a key, access to a key safe or for someone to be home.

If you would like your dog walking while at the centre do you give us permission for them to be let off the lead? (They must have a good recall)

Suitability

Assessments are conducted, usually in a three hour time slot where we carry out a detailed assessment to establish your dog’s suitability for our centre. We ask that owners are contactable for the duration of the initial assessment and available to collect your dog earlier than specified in the event that your dog struggles to settle in. It’s important for your dogs first experience to be a happy one and therefor it may be necessary for us to shorten the assessment length. There may be occasions where we recommend a gradual introduction to our centre to best support your dogs welfare as they settle in to the new environment. There also may be occasions where we are unable to accept a dog for day care, this could be due to medical reasons or behaviours displayed during the assessment, please note that if this is the case, we will do our best to advise alternative care where possible and the decision is not a negative view on you or your dog.

Terms and Conditions (please read and sign) Liability

I (the owner) confirm to Mansfield Doggy Day Care that I am the legal owner of my dog; that to my knowledge my dog has not been ill with any contagious disease or condition within the past 30 days and that my dog has received all necessary vaccinations and or been titre tested.

I understand that my obligations under the control of dog’s act 1992 states that my dog (s) must wear a collar and identity tag in a public place and this is also a requirement for attending day care.

I understand it is the law to have my dog microchipped and must provide an identity chip number.

I understand that Mansfield Doggy Day Care is a facility that involves dogs playing and socialising off lead in groups. I accept that there are inherent risks involved in this and Mansfield Doggy Day Care will not be liable for any injuries, illness or medical costs resulting from my dog’s attendance.

If my dog is a puppy (under the age of 12 months old), I understand and give Mansfield Doggy Day Care permission to allow my puppy to mix with adult dogs over the age of 12 months old where Mansfield Doggy Day Care deem that it is safe to do so.

I understand and agree that Mansfield Doggy Day Care may temporarily suspend or permanently terminate my dogs registration based on behavioural reasons, and or medical reasons, and or breaches to terms and conditions.

I allow and consent to my dog being photographed/ videoed and understand that this may be displayed/ published or used in advertising/media.

I have disclosed to Mansfield Doggy Day Care all relevant information regarding my dog’s history and understand it is my responsibility to keep Mansfield Doggy Day Care informed of any changes to my dogs’ behaviour, circumstances or health in the future.

I waive all claims against Mansfield Doggy Day Care, its employees and representatives, except those arising from gross negligence on the part of Mansfield Doggy Day Care.

If any medical problems develop while my dog is in the care of Mansfield Doggy Day Care and I cannot be contacted, I authorise them to do whatever they deem necessary for the safety, health and wellbeing of my dog and I agree to pay all expenses incurred.

Payments

All Payments for day care are to be paid upfront for your dog. (discounts available for weekly/monthly bulk bookings and multiple dogs from the same household)

Acceptance of all Terms and Conditions. I have read and agree to all the terms and conditions related to this day care application.

Signed / Print Name / Date: