ENROLLMENT FORM
We take FUNnnnnn seriously!
Are you PAAAWSitively BORED …
Tired of being “under~foot” & told to “GET OFF THE COUCH” … WANNAAAAAAA PLAY??? MAKE NEW FRIENDS ~ ???
Have your PARENTS fill out these forms and e-mail them or bring them with you when come for your
*COMPLIMENTARY* EVALUATION CONSULTATION
(*EVALUATIONS ARE BY APPOINTMENT ONLY PLEASE~MONDAY THRU FRIDAY)
Please tell us how you heard about K9-Playtime:
K9-Training / Agility Class
Newspaper
Yelp
Facebook
PARENT’S INFORMATION :
LAST NAME :
Client / Vendor Referral:
Mom :
Dad :
ADDRESS :
CITY :
ST :
ZIP :
MOM’S CELL :
DAD’S CELL :
HOME PHONE :
MOM’S EMAIL:
DAD’S EMAIL:
In case we can’t find your
mom & dad~
…
CONTACT :
PHONE :
Any 2 Legged Kids at home :
PET’s INFORMATION
:
YOUR NAME :
(Don’t forget to fill-in your birthday DATE / YEAR ~ they LOVE an excuse to PARTY !!!)
BROTHER / SISTER’S NAME
:
NATIONALITY (BREED) :
NATIONALITY (BREED)
:
“HAIR” COLOR :
“HAIR” COLOR :
SEX : M
F
SEX : M
F
SPAYED/NEUTERED : Y
N
SPAYED/NEUTERED : Y
N
When were
you born :
was he / she born :
DOCTOR’S
INFORMATION
:JUST in CASE you’reWhen
not feeling well …
HOSPITAL :
YOUR
PHONE
Does your
brother
/
sister
use
the
same
Doctor
as
you ? :
DOCTOR :
GROOME
R:
Y
N
Tell us ANYTHING else we should know about you to make your day even MORE FUNNER~er …
Apr 2014 /skl
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What YOU need to know about …
K-9 PlayTime Inc.
We take FUNnnnnn seriously !!!
All pets must pass our temperament evaluation prior to entering play~care. All pets must be non aggressive to people and other
pets. Parents will certify that their pet(s) have not harmed or shown any aggression toward any person or pet. Please remember that
your pet will be playing with other pets & their safety & health is our primary concern. Also, please remember that although they are
supervised at all times, your pet may still go home with a scratch or nip at some point.
All pets MUST be up to date on the following vaccinations :
1) DHLPP (Distemper)
2) RABIES (puppies under 6 months may participate with Rabies vaccine)
3) BORDATELLA
AND ~ be in good health. We are happy to remind you when vaccines are due however we do require that you provide us with a
copy of your pet’s vaccines from a licensed veterinarian for our files & ALL UPDATES
A few things to keep in mind :
 Pets not regularly exposed to this level of activity may feel soreness and/or fatigue
 Pets not regularly exposed to play on this surface may experience sore paws, blisters, or raw paws
 Pets at play can get dirty. Longer hair can get matted from the level of activity
 Water is available at all times, however, your pet may still be thirsty at the end of the day
 Any behavior deemed dangerous or inappropriate may result in “early” dismissal and/or suspension IE: incidents including,
but not limited to, bites, fights, fear aggression, resource guarding behavior problems and/or acting out
PARENT'S UNDERSTANDING & AGREEMENT :
(Please read & initial the following)
 I understand that there are risks with my dog while attending a day care facility & as owner I agree to be solely responsible for all acts &
behaviors of the animal at any time during the term of this agreement, including any medical bills which may ensue for the behaviors of
this animal & in no case shall K9 Playtime, Inc. be liable for the animal's acts & behaviors other than for the exercise of gross negligence
on the part of K9 Playtime, Inc. , it's agents or employees, in the keeping of the animal.
 That K9 Playtime, Inc. will exercise ordinary & responsible care of all of the animals under their care at all times but K9 Playtime, Inc.
shall not be under any obligation to guard against injuries which it has no reason to expect on account of the disposition of an individual
animal.
 K9 Playtime, Inc. shall not be liable & the owner releases K9 Playtime, Inc. for any damages or injuries to the animal arising out of or
from the keeping of the animal or that may accrue from any cause whatsoever in connection with the keeping including theft, running
away, loss by fire, injury or death while under the care of K9 Playtime, Inc. during the term of this agreement except where any such loss is
caused by the neglect or intentional act of the corporation or by any of K9 Playtime, Inc. 's agents or employees.
 Owner shall indemnify, defend & hold harmless K9 Playtime, Inc., it's agents & employees against all damages sustained by reason of
keeping of the animal for any claims or injuries whatsoever arising out of the keeping of the animal by K9 Playtime, Inc.
 I understand and agree that in accepting my pet into daycare, K-9 PlayTime, Inc. has relied on my representation that my pet (s) have not
harmed or shown aggression toward anyone.
 I certify that my pet(s) are in good health and has/have not been ill with any communicable disease within the last 30 days.
 I hereby release K-9 Play Time, Inc., it’s agents, officers, subcontractors, employees, animal parents, customers and potential customers
from any and all liabilities for injuries to myself, my pet or any other property of mine which arise in any way out of services and/or
products provided.
 I acknowledge that there are certain risks involved in participating in playcare, including but not limited to fights, bites, injury and the
transmission of disease.
 In case of emergency and transport services to a veterinary clinic are necessary, I recognize the risks of injury that accompany said
transport and acknowledge that this Agreement is being relied upon to permit transport of my pet to and from any veterinary clinic, and or
necessary location
DATE :
PARENT’S SIGNATURE :
PARENT’S PRINTED NAME :
RELEASE &
INDEMNIFICATION
AGREEMENT
Jan ’12 /skl
(2 OF 3)
ENENROLLMENT & K9 ~
EVENTS
LAST NAME
:
DATE :
FIRST NAMES
:
PET’s NAME :
I, the undersigned, as the OWNER (hereinafter "OWNER”) of the dog(s) named above. hereby enter into this Release and
Indemnification Agreement (hereinafter the "Agreement") with K-9 Play Time, Inc. an Illinois corporation (hereinafter, "K-9").
In consideration for services provided and to be provided by K-9, I hereby agree as follows:
K-9 watches dogs carefully, and DOES NOT accept aggressive dogs.10. K-9 cannot be held responsible for injuries occurring
while the dogs are playing. I agree to release and discharge K-9 and its owners, officers, employees, instructors and any other person
associated with K-9 from any and all liability arising out of or in any way connected or associated with any accident and/or injury that may
arise from services provided by K-9 or attendance of any and all functions at K-9 even though that liability may arise allegedly or actually
from any actions whatsoever of K-9 or persons or entities acting on K-9's behalf.
I agree to indemnify and hold harmless K-9 and its owners, officers, employees, instructors and any other person associated with
K-9 from any and all claims for personal injury and/or property damage of any member of the OWNER’S family and/or other person
accompanying the OWNER to any activity or function on K-9's premises, property or surrounding area thereto, including without limitation
attorneys' fees and costs.
I agree to hold K-9 and it's owners, officers, employees, volunteers, instructors and/or any other person associated with K-9
harmless from any and all claims, costs and attorney's fees from any claim based on the OWNER’S negligent use of K-9's premises or claims
arising through the ownership of the OWNER’S dog(s).
This Release and Indemnification Agreement supersedes all previous such agreements with K-9 and can only be amending in a
writing signed by both OWNER and K-9. This Release and Indemnification Agreement is binding on myself and my heirs,
representatives, and administrators.
I ACKNOWLEDGE AND AGREE THAT I HAVE READ AND FULLY UNDERSTAND THE TERMS OF THE ABOVE AGREEMENT
INCLUDING WITHOUT LIMITATION THE FOREGOING RELEASE AND WAIVER OF CLAIMS AND AGREEMENT OF
INDEMNIFICATION.
SIGNATUR
E:
DATE :
Release and Indemnification Agreement
403 Washington Blvd., Unit 1
Mundelein, IL 60060
847-970-7529
April 2014 /skl
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