22497 Heslip Dr.
Novi, MI 48375-4138
248-347-9081 Phone
248-347-8956 Fax
Novi, MI 48375-4138
248-347-9081 Phone
248-347-8956 Fax
Owner’s Information
Name:
______________________________________________________________________________
Complete Mailing Address:
______________________________________________________________________________
Home Phone: __________________________ Cell Phone: _________________________
Employer: _____________________________ Work Phone: ________________________
Email address: _________________________________________________________________
May we contact you via email for vaccination reminders? Yes / No
*Emergency person to contact if we cannot reach you:
Name: _________________________________ Phone: ____________________________
*Gone To The Dogs reserves the right to seek veterinary care for your dog, at any time while on the
premises and at our sole discretion. Please see Rules and Regulations for additional information.
Gone To The Dogs will not release your dog except to the registered owner above or to those
persons listed here:
__________________________ _________________________ ________________________
CREDIT CARD INFORMATION:
Card Type: _____________ Card #: ______________________________ Exp Date: _________
V-code (three digit code on back):______________________
*We reserve the right to bill clients card if service is not paid for when dog is picked up!
How did you hear about Gone To The Dogs?
______________________________________________________________________________
Pet Information
Name: ________________________________ Breed: _______________________________
Birth date: __________________ Color: _____________________ Weight: ___________
Sex: ___________ Neutered? ___________
Veterinarian Information
Name/Hospital:
_____________________________________________________________________________
Address:
_____________________________________________________________________________
Phone: _______________________________ Fax: ______________________________
Pet Personality Profile
How long have you had your dog? __________________________________________________
Where did you get your dog? ______________________________________________________
If adopted, do you have any information on your dog’s history? ___________________________
_____________________________________________________________________________
Does your dog like children? ______________________________________________________
Which flea preventative do you use? ________________________________________________
Does your dog have any health issues that would cause restrictions on activities or movements?
_____________________________________________________________________________
Does your dog have any allergies? _________________________________________________
Does your dog go to dog parks? ___________________________________________________
If yes, how does he/she get along? _________________________________________________
_____________________________________________________________________________
What does your dog do when you are not at home? ____________________________________
_____________________________________________________________________________
Are there any people your dog automatically fears or dislikes? ____________________________
_____________________________________________________________________________
Are there any dogs your dog automatically fears or dislikes? _____________________________
_____________________________________________________________________________
How does your dog react to puppies or small dogs? ____________________________________
_____________________________________________________________________________
Has your dog ever growled or snapped at anyone who has tried to take food or toys away?
_____________________________________________________________________________
_____________________________________________________________________________
Has your dog ever bitten anyone? If yes, please explain. _________________________________
______________________________________________________________________________
Has your dog ever climbed a fence? _________________________________________________
Is there any other information that you think we should know? _____________________________
______________________________________________________________________________
______________________________________________________________________________
Daycare Terms & Conditions
The goal of Gone To The Dogs is to provide a safe, fun and stimulating social environment for dogs
during the day. To ensure the safety and health of your pet and that of our other guests, we
require everyone to comply with the following:
DAYS & HOURS: We are open Monday – Friday from 7:00am to 6:30pm. Dogs not picked up
before our 6:30pm closing time will incur a $25 late pick-up fee unless prior arrangements were
made due to special circumstances.
RESERVATIONS: Reservations are required for daycare and must be paid for in advance.
Preference will be given to those who attend regularly. Cancellations not received at least 24 hours
in advance will be charged the regular fee for that day.
APPLICATION: All dogs must have a complete, up-to-date and approved application on file.
Applications and screening evaluations are good for up to six months from the date of your dog’s
last stay with us in daycare. If more than six months have past since your dog’s last stay with us in
daycare, a new application and evaluation will have to be completed. There is a $10 non-
refundable application/screening fee.
AGE: All dogs must be four months or older. All dogs six months and older must be spayed or
neutered.
VACCINATIONS: All dogs must have up-to-date vaccinations. Owners must provide vaccination
certificates proving that their dog(s) has received DHLPP (Distemper, Hepatitis, Leptospirosis,
Parainfluenza, and Parvovirus), negative Heartworm test and negative Fecal test within the last
year, and that the Kennel Cough (Bordetella) vaccine was received within the last six months.
Rabies vaccination must also be current.
Flea prevention is strongly recommended but not mandatory. Gone To The Dogs is not responsible
if your dog contracts fleas.
HEALTH: All dogs must be in good health. Owners will need to verify that their dog(s) is in good
health and has not been ill with a communicable condition in the last 30 days. On admission, all
dogs must be free from any condition that could potentially jeopardize themselves or other guests.
All dogs are required to have a veterinarian certification of good health after any illness.
VETERINARY CARE: Your dog’s health and well-being are one of our top concerns. We reserve
the right to seek veterinary care for any illness or injury, at our sole discretion, while your dog is in
our care. Whenever possible, we will attempt to call you or your emergency contact to discuss the
matter ahead of time. However, if circumstances do not permit the time necessary to call or if we
are unable to reach you or your emergency contact, we will proceed as we see fit. Briarpointe
Veterinary Clinic will provide the veterinary services unless they are unavailable or unable to do so
at the time; In which case, we reserve the right to seek an alternative source. You will be
responsible for all charges incurred for any veterinary care and related services provided to your
dog while in our care.
RESPONSIBILTY WAIVER – HOLD HARMLESS AGREEMENT: By submitting this application, I
hereby acknowledge that dog-daycare activities are not without risk. I further acknowledge that I
personally, am solely responsible for my dog’s behavior and actions at all times. I expressly assume
the risk of any injury or illness to my dog and to any damage of property while on the premises,
caused by my dog. I absolve Dog Obedience Training LLC, Gone to the Dogs LLC and Gone to
the Dogs Daycare LLC along with all persons associated with the above, from any responsibility for
any harm to persons, property or animal while on or off the premises for any reason. I also hereby
indemnify and hold harmless release Dog Obedience Training LLC, Gone to the Dogs LLC and
Gone to the Dogs Daycare LLC along with officers, employees, members and agents from any and
all claims, or claims by any member of my family or claims by any other person accompanying me.
BEHAVIOR: All dogs must be non-aggressive towards humans and other dogs. They also must
not be object or food possessive or aggressive. Owners will need to certify that their dog(s) has not
harmed or shown any aggressive or threatening behavior towards any person or other dog(s).
Please remember that your pet will be spending time with other pets and that their safety and health
is our main concern.
Any dog which, in the opinion of Gone To The Dogs, is uncontrollable, unpredictable, aggressive, or
in any way a danger to people or other dogs will be removed from daycare and asked not to return.
BILLING POLICIES: If payment is not provided by the time your dog is picked up, we reserve the
right to charge your credit card on file. If your credit card is denied you may be refused future
services and any discounted fees will revert to the full rate. There will be a $25 fee for all in-
sufficient funds or stop payment made on any check and a late fee of $25 per month will be
incurred on all outstanding invoices. We are a small business and appreciate your prompt payment.
I have read and understand these Terms & Conditions:
____________________________________________________
Signature
Name:
______________________________________________________________________________
Complete Mailing Address:
______________________________________________________________________________
Home Phone: __________________________ Cell Phone: _________________________
Employer: _____________________________ Work Phone: ________________________
Email address: _________________________________________________________________
May we contact you via email for vaccination reminders? Yes / No
*Emergency person to contact if we cannot reach you:
Name: _________________________________ Phone: ____________________________
*Gone To The Dogs reserves the right to seek veterinary care for your dog, at any time while on the
premises and at our sole discretion. Please see Rules and Regulations for additional information.
Gone To The Dogs will not release your dog except to the registered owner above or to those
persons listed here:
__________________________ _________________________ ________________________
CREDIT CARD INFORMATION:
Card Type: _____________ Card #: ______________________________ Exp Date: _________
V-code (three digit code on back):______________________
*We reserve the right to bill clients card if service is not paid for when dog is picked up!
How did you hear about Gone To The Dogs?
______________________________________________________________________________
Pet Information
Name: ________________________________ Breed: _______________________________
Birth date: __________________ Color: _____________________ Weight: ___________
Sex: ___________ Neutered? ___________
Veterinarian Information
Name/Hospital:
_____________________________________________________________________________
Address:
_____________________________________________________________________________
Phone: _______________________________ Fax: ______________________________
Pet Personality Profile
How long have you had your dog? __________________________________________________
Where did you get your dog? ______________________________________________________
If adopted, do you have any information on your dog’s history? ___________________________
_____________________________________________________________________________
Does your dog like children? ______________________________________________________
Which flea preventative do you use? ________________________________________________
Does your dog have any health issues that would cause restrictions on activities or movements?
_____________________________________________________________________________
Does your dog have any allergies? _________________________________________________
Does your dog go to dog parks? ___________________________________________________
If yes, how does he/she get along? _________________________________________________
_____________________________________________________________________________
What does your dog do when you are not at home? ____________________________________
_____________________________________________________________________________
Are there any people your dog automatically fears or dislikes? ____________________________
_____________________________________________________________________________
Are there any dogs your dog automatically fears or dislikes? _____________________________
_____________________________________________________________________________
How does your dog react to puppies or small dogs? ____________________________________
_____________________________________________________________________________
Has your dog ever growled or snapped at anyone who has tried to take food or toys away?
_____________________________________________________________________________
_____________________________________________________________________________
Has your dog ever bitten anyone? If yes, please explain. _________________________________
______________________________________________________________________________
Has your dog ever climbed a fence? _________________________________________________
Is there any other information that you think we should know? _____________________________
______________________________________________________________________________
______________________________________________________________________________
Daycare Terms & Conditions
The goal of Gone To The Dogs is to provide a safe, fun and stimulating social environment for dogs
during the day. To ensure the safety and health of your pet and that of our other guests, we
require everyone to comply with the following:
DAYS & HOURS: We are open Monday – Friday from 7:00am to 6:30pm. Dogs not picked up
before our 6:30pm closing time will incur a $25 late pick-up fee unless prior arrangements were
made due to special circumstances.
RESERVATIONS: Reservations are required for daycare and must be paid for in advance.
Preference will be given to those who attend regularly. Cancellations not received at least 24 hours
in advance will be charged the regular fee for that day.
APPLICATION: All dogs must have a complete, up-to-date and approved application on file.
Applications and screening evaluations are good for up to six months from the date of your dog’s
last stay with us in daycare. If more than six months have past since your dog’s last stay with us in
daycare, a new application and evaluation will have to be completed. There is a $10 non-
refundable application/screening fee.
AGE: All dogs must be four months or older. All dogs six months and older must be spayed or
neutered.
VACCINATIONS: All dogs must have up-to-date vaccinations. Owners must provide vaccination
certificates proving that their dog(s) has received DHLPP (Distemper, Hepatitis, Leptospirosis,
Parainfluenza, and Parvovirus), negative Heartworm test and negative Fecal test within the last
year, and that the Kennel Cough (Bordetella) vaccine was received within the last six months.
Rabies vaccination must also be current.
Flea prevention is strongly recommended but not mandatory. Gone To The Dogs is not responsible
if your dog contracts fleas.
HEALTH: All dogs must be in good health. Owners will need to verify that their dog(s) is in good
health and has not been ill with a communicable condition in the last 30 days. On admission, all
dogs must be free from any condition that could potentially jeopardize themselves or other guests.
All dogs are required to have a veterinarian certification of good health after any illness.
VETERINARY CARE: Your dog’s health and well-being are one of our top concerns. We reserve
the right to seek veterinary care for any illness or injury, at our sole discretion, while your dog is in
our care. Whenever possible, we will attempt to call you or your emergency contact to discuss the
matter ahead of time. However, if circumstances do not permit the time necessary to call or if we
are unable to reach you or your emergency contact, we will proceed as we see fit. Briarpointe
Veterinary Clinic will provide the veterinary services unless they are unavailable or unable to do so
at the time; In which case, we reserve the right to seek an alternative source. You will be
responsible for all charges incurred for any veterinary care and related services provided to your
dog while in our care.
RESPONSIBILTY WAIVER – HOLD HARMLESS AGREEMENT: By submitting this application, I
hereby acknowledge that dog-daycare activities are not without risk. I further acknowledge that I
personally, am solely responsible for my dog’s behavior and actions at all times. I expressly assume
the risk of any injury or illness to my dog and to any damage of property while on the premises,
caused by my dog. I absolve Dog Obedience Training LLC, Gone to the Dogs LLC and Gone to
the Dogs Daycare LLC along with all persons associated with the above, from any responsibility for
any harm to persons, property or animal while on or off the premises for any reason. I also hereby
indemnify and hold harmless release Dog Obedience Training LLC, Gone to the Dogs LLC and
Gone to the Dogs Daycare LLC along with officers, employees, members and agents from any and
all claims, or claims by any member of my family or claims by any other person accompanying me.
BEHAVIOR: All dogs must be non-aggressive towards humans and other dogs. They also must
not be object or food possessive or aggressive. Owners will need to certify that their dog(s) has not
harmed or shown any aggressive or threatening behavior towards any person or other dog(s).
Please remember that your pet will be spending time with other pets and that their safety and health
is our main concern.
Any dog which, in the opinion of Gone To The Dogs, is uncontrollable, unpredictable, aggressive, or
in any way a danger to people or other dogs will be removed from daycare and asked not to return.
BILLING POLICIES: If payment is not provided by the time your dog is picked up, we reserve the
right to charge your credit card on file. If your credit card is denied you may be refused future
services and any discounted fees will revert to the full rate. There will be a $25 fee for all in-
sufficient funds or stop payment made on any check and a late fee of $25 per month will be
incurred on all outstanding invoices. We are a small business and appreciate your prompt payment.
I have read and understand these Terms & Conditions:
____________________________________________________
Signature
| HEALTH REQUIREMENTS FOR ALL DOGS ENTERING OUR FACILITY Vaccinations • Rabies • DHLPP • Bordetella - every 6 months • Negative heartworm test • Negative fecal test We must have current records on file at all times. All dogs must be brought in on a leash! |
Copyright © 2004 GoneToTheDogsNovi.com
| Application For Doggie Daycare |
