Tuscan Ridge Animal Hospital
Camp De Canine Daycare Consent & Agreement
Client Name: _________________________
Dog’s name: _______________
In order to establish a safe and healthy environment for all day camp participants,
Tuscan Ridge Animal Hospital requires that all dogs attending day camp provide
proof of required vaccinations annually and a fecal examination every 6 months.
Further, all dogs will be inspected for the presence of fleas and ticks prior to
admission to the camp program. In the event that your dog is found to have fleas,
a rapid-acting, oral flea preventative will be administered by our hospital staff to
prevent spread to other campers in the program.
Please bring a copy of your pet’s vaccination history with you when you arrive for
camp. Alternatively, you may have your records sent to us prior to your Day
Camp reservation via fax or email at:
919-556-2363
or
[email protected]
I verify that the afore named dog is in good health and to my knowledge has not
shown clinical signs of any communicable disease within the past 14 days. I
further certify that the dog has shown no signs of aggressive or threatening
behavior toward people or other dogs.
_______________________________________
Signature of Owner
__________
Date
1
Please review the consent information below carefully and initial next to each paragraph to
indicate confirmation that you have read and understand the following about Camp De Canine:
________
I understand that attendance by my dog in this day care program involves group
play with other dogs. Although the staff at this facility
will closely supervise all day camp participants, I accept that play behavior can
result in altercations and/or injury. I assume the risks of and responsibility for
the costs incurred to treat any injuries sustained during day camp at this facility.
I further understand and accept that in the absence of negligence, the owners
and staff will not be held liable for any injuries or deaths related to my dogs’
participation in this day camp program.
_________
In the event that my dog contracts a communicable disease during the time
he/she is attending this program, I assume the subsequent health risks therein
and accept responsibility for all costs for treatment as needed. I also agree to
withhold my dog from this program until he/she has been free of any signs of
communicable disease for at least 48 hours or as has been deemed safe for
return to group play by our veterinarian. Although risks of acquiring
communicable disease are small, I nonetheless accept them and in the absence
of negligence agree to hold this facility, the owners and staff harmless from any
expense incurred for treatment.
_________
I understand and agree that if the need arises emergency medical care for my
pet will be provided by Tuscan Ridge Animal Hospital. I agree to pay for all
reasonable costs for such treatment. I have been informed that someone from
Tuscan Ridge Animal Hospital will contact me as soon as the situation is stable at
which time authorization for further care will be transferred to me.
I have read this consent form and understand that inherent health and safety risks associated
with participation in the Camp De Canine program. I have been encouraged to discuss any
concerns I have about these risks and have had my questions answered to my satisfaction.
_____________________________________
Signature of Owner
____________________
Date
2
3