PDX Boarding and Daycare Application & Agreement Step 1 of 5 – Owner Details 0% Owner's Name(Required) Address(Required) Street Address City State / Province / Region ZIP / Postal Code Cell PhoneHome PhoneWork PhoneEmail Dog's Name Breed Color Birth Date Month Day Year Weight Sex Male Female Neutered/spayed? (Dogs over 8 mos must be neutered/spayed for daycare & boarding services) Yes No Flea and tick control method Worm control method Medical InformationVeterinary Clinic(Required) Vet's Name Shot Records Attached I have contacted my vet with request to fax to 866-370-7821 Please attach Drop files here or Select files Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 20 MB, Max. files: 10. Describe any medical information, conditions, allergies, or considerations that your dog may have:History & socialIs your dog good with other dogs? Yes No Does your dog have separation issues? Yes No Has your dog ever bitten a person? Yes No Does your dog climb or jump fences? Yes No Does your dog have any formal training? Yes No Is your dog housebroken? Yes No Services RequestedServices Requested Boarding Daycare (weekly) Day Boarding Grooming How did you hear about us?How did you hear about us? Location Newspaper Vet Yellow Pages Website Word of mouth Other Please specifyEmergency Contact and Authorized Pickup(in case owner cannot be reached)Name(Required) Primary Phone(Required)Alt PhoneEmergency Contact – May pick up May pick up For daycare services onlyHas your dog ever attended daycare before? Yes No Is your dog crate trained? Yes No Has your dog ever bitten another dog? Yes No Has your dog ever been attacked by another dog? Yes No Does your dog guard food or toys? Yes No How old was your dog when you got him? <5 months <12 months <3 years Older Where did you get your dog? Breeder Rescue Friend Other Regular attendance is required for the daycare program:Daycare days requested Monday Tuesday Wednesday Thursday Friday PDX agrees to exercise due diligence and care in the handling of dogs, and to keep the facility properly enclosed and sanitary. PDX reserves the right to refuse services or admittance to any dog. Dogs that have harmed or shown aggression or threatening behavior to any person or other dog will not be admitted to daycare for group play. If this pet becomes ill or injured, or if the state of the animal’s health otherwise requires professional attention, PDX, in its sole discretion, may engage the services of a veterinarian or administer medicine or give other requisite attention to the animal, and the expenses thereof shall be paid by the owner. The owner of the dog agrees to hold PDX harmless against any claims for losses or damages of any kind whatsoever. The owner further agrees to be solely responsible for any and all acts or behavior of this pet while it is in the care of the pet care provider, to include payment of costs for injury to staff or other animals or damage to facilities caused by the pet. Owner agrees that their dog(s) may be videotaped and/or photographed. PDX will be the exclusive owner of the resulting media. The owner also agrees that their dog(s) may be used in published material promoting, publicizing, or advertising PDX You agree to receive reminders and announcements via email, text message, voice mail, or by regular mail at our discretion. You may opt out of any particular format. Please check each statement below to acknowledge your understanding and acceptance: I understand that there are inherent risks in group play, including nicks, scratches, sprains, bruises, and spreading of disease.(Required) I understand that there are inherent risks in group play, including nicks, scratches, sprains, bruises, and spreading of disease.(Required)I understand and agree to take full responsibility for any problems, damage, or injury caused by me, my family, my guests, or my dog.(Required) I understand and agree to take full responsibility for any problems, damage, or injury caused by me, my family, my guests, or my dog.(Required)I understand that Play Dog Excellent communicates via text and email messaging. PDX does not share or sell information nor do we use text or email for marketing.(Required) I understand that Play Dog Excellent communicates via text and email messaging. PDX does not share or sell information nor do we use text or email for marketing.(Required)I certify that I have read and understand, and agree to abide by the terms of this agreement.Owner's Signature(Required) Reset signature Signature locked. Reset to sign again Print Name(Required) Date(Required) Month Day Year Δ
