Required Daycare & Boarding Form


Derry Registration

*Please fill out one form per pet. All fields require an answer. If the question does not apply to your dog, please type “n/a”.

OWNER INFORMATION

Select Location*
Name of Owner (s)*
Street Address*
City*
State*
Zip*
Home Phone*
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Cell Phone 1*
-
Work Phone
-
Cell Phone 2
-
E-mail:*

EMERGENCY CONTACT INFORMATION

Emergency Contact*
Contact Phone*
-
Relationship to Owner
Persons Authorized for Pickup Other Than Owner*
Pet Name*
Breed*
Pet Type*
(other)
Color*
Markings
Weight*
Sex*
Date of Birth*
Spayed/Neutered*
Veterinarian*
Phone:*
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FEEDING SCHEDULE
(Please indicate which meals your pet eats and how much they get)

Breakfast
Lunch
Dinner
Would you prefer to use our food, Pro Pac Chicken and Rice dry kibble?*
If not, please specify brand and type used.
In case of emergency overnight or customer provided food runs out during their stay is your pet allowed to have our dry kennel food?*
Special Instructions
Any long term medical problems that we should be aware of? If yes, please explain.
Is your pet on any long term medications? If so, please explain.

GETTING TO KNOW YOUR PET
Please complete the following questions. It is helpful for us to have information on the pet’s background. This information assists us in introducing your pet to our daycare program.
If you have a cat or an exotic please check NO or write N/A in the required fields that do not apply to you.

1. Do you currently use a crate at home?*
2. Are there other dogs in your home?*
(Please list age and breed)
3. Is there anything your dog does not tolerate (check all that apply).
other:
4. Has your dog had prior interactive daycare, play group or obedience training?
How was the experience?
5. Does your dog ever growl or snap at other dogs? *
6. Has your dog ever bit another dog?*
How severe?
What was the situation in general?
7. Has your dog ever been bitten by another dog? *
How severe was the bite?
What was the situation?
8. Does your dog ever growl at you or anyone else for any reason, even while playing?*
How severely?
Provide details of the situation.
9. Has your dog ever bit a person?*
10. Is there any specific dog(s) or breed(s) that your dog tends to dislike? (If no, write N/A. If yes, Please explain.)*
11. Does your dog enjoying playing with (check all that apply)
12. How does your dog act around other dogs? (check all that apply)
13. Does your dog have any allergies?*
If Yes to allergies, please explain.
14. Does your dog have any physical limitations? (If no, write N/A. If yes, please explain.)
15. Is there any additional information you would like to tell us about your dog?

PET REGISTRATION AGREEMENT
This is a contract between The Barking Dog, Ltd. (hereinafter called the “Company”) and the pet owner whose signature appears below (hereinafter called “Owner”).

  1. The Owner specifically represents that he or she is the sole owner of the pet.
  2. The Owner certifies that all information given about said pet is accurate.
  3. The Owner specifically represents to the Company that the pet has not been exposed to rabies, canine/feline distemper, or canine cough within a thirty-day period prior to boarding.
  4. The Owner agrees to be solely responsible for any and all acts or behavior of said pet(s) while the pet(s) is in the care of the Company.
  5. The Company shall exercise reasonable care for the pet(s) delivered by the Owner to the Company for boarding, daycare, grooming, training or other services. The Owner agrees that despite the efforts of The Barking Dog, Ltd. staff to provide a safe environment, there may be unpredictable or unforeseeable circumstances that may expose Owners and/or their pet(s) to health risks or injury. The Owner hereby waives and releases The Barking Dog, Ltd., it's employees, owners and agents from any claims while Owners and/or their pets are on the property.
  6. If the pet(s) becomes ill, or the state of health or well-being otherwise requires professional attention, the Company, at it's sole discretion, may engage the services of a veterinarian or administer medicine or other requisite attention to the animal, and it is agreed that all costs and charges thereof shall be paid by the Owner.
  7. The Owner agrees to pay all costs and charges for services he/she requests.
  8. All charges incurred by the Owner shall be payable at the time the pet(s) is discharged from the Company. The Owner agrees that in the event the charges are not paid in accordance with this contract and proper notice is given, the Company may exercise it's rights regarding liens, abandonment consideration and disposal in accordance with State Statute subdivisions 437:19 and 437:20.
  9. For long-term boarding arrangements, the Company, at its sole discretion, may require a deposit before agreeing to provide services. The Owner agrees to pay such deposit, as required.
  10. Owner understands and acknowledges that from time to time, for the purpose of training, and/or advertising and/or promoting its business, the Company takes photographs of its employees and programs, including pets on site.  In consideration of the Company’s agreement to accept Owner’s pet for participation in its programs Owner hereby releases from liability and licenses to Company the right to use any photos of or including Owner’s pet for any lawful purpose(s) including training materials, advertising and/or promotional materials.
  11. This Contract contains the entire agreement between the parties. All terms and conditions of this Contract shall be binding on the heirs, administrators, personal representatives and assignees of the Owner and the Company.  This contract is entered into and shall be interpreted under the laws of the State of New Hampshire.  Owner agrees to submit to the jurisdiction of only the New Hampshire Courts with respect to any dispute relating to this agreement and/or the Owner or Owner’s pet’s relationship with the Company.
  12. This Contract is binding for the present and all subsequent engagements for services of the Company by the Owner.

I hereby acknowledge that I have read all of the above and agree as the Owner of the animal(s) foregoing.

Electronic Agreement Signature*
Date:*