The Posh Pooch Doggy Daycare for Small-Breed Dogs
Application Form
Please fill out all information on Pages 1 – 5 and enter your
name on the last page to signify agreement with the terms
and conditions of our doggy daycare.
Please use the TAB key to move from entry to entry
13 Cook Street, Howick, Auckland 2014
t: 09 537 1486 | e: [email protected] | www.theposhpooch.co.nz
Page |1
Owner Information
Title
First Name
Last Name
Choose Title
Enter First Name
Enter Last Name
Home Phone
Work Phone
Mobile Phone
Enter Home Phone
Enter Work Phone
Enter Mobile Phone
Partner/Spouse
Last Name
Title
First Name
Choose Title
Enter First Name
Enter Last Name
Home Phone
Work Phone
Mobile Phone
Enter Home Phone
Enter Work Phone
Enter Mobile Phone
My partner/spouse can pick my dog up
Choose Yes/No
Emergency Contact / Pick Up (In case you are not available)
Title
First Name
Last Name
Choose Title
Enter First Name
Enter Last Name
Home Phone
Work Phone
Mobile Phone
Enter Home Phone
Enter Home Phone
Enter Home Phone
My emergency contact can pick my dog up
Choose Yes/No
How many dogs are in your household?
How did you hear about us?
Please Select
Please Select
Page |2
Information about your Dog
Dog’s Name
Breed
Sex
Enter dog’s Name
Enter Dog Breed
Choose
Age
Birthday
Desexed?
Enter Dog’s Age
Enter Dog’s Birthday
Choose
Colour
License Number
Microchip Number
Enter Colour
Enter Dog’s License
Enter Dog’s Microchip #
Where did you get your dog from?
How long have you owned your dog?
Choose Here
Years Months
Months
Veterinarian Information
Vet Practice
Choose your dog’s veterinarian practice or enter details if it is not listed
Preferred Vet
Enter your preferred vet’s name if known
Dog Medical and Health
Vaccinations
Core Vaccine
Date Received
Choose Core Vaccination
Date received
Leptospirosis
Date Received
Choose Yes/No
Date received
Kennel Cough (Bordetella bronchiseptica)
Choose Yes/No
Date received
Parainfluenza Virus
Choose Yes/No
Date Received
Flea / Worms
Date received
Date Due
Choose Yes/No
Date received
Date Due
Page |3
Any Medical Condition(s)?
Please Detail
Choose Yes/No
Enter medical conditions
Recent / Current Injuries?
Please Detail
Choose Yes/No
Details of Injuries
Taking Any Medication?
Please Detail
Choose Yes/No
Details of medications
Does your dog need medication
while at daycare?
If Yes, Please Describe
Choose Yes/No
Details of medication at Daycare
Do you want us to give your dog the required medication during the day?
Choose Yes/No
Allergies / Food Sensitivity
Choose Yes/No
Please Detail
Details of allergies & food sensitivity
Information about your Dog
Where is your dog most of its days?
Is your dog allowed on furniture? / bed?
Enter Here
Choose Yes/No
Is your dog housetrained?
How often does your dog bark?
Is chewing a problem?
Choose Yes/No
Choose frequency
Choose Yes/No
Attributes that describe your dog's personality
Outgoing
Independent
Timid
Affectionate
Choose Yes/No
Choose Yes/No
Choose Yes/No
Choose Yes/No
Page |4
Reserved
Confident
Choose Yes/No
Choose Yes/No
Choose Yes/No
Choose Yes/No
Clingy
Excitable
Playful
Gentle
Choose Yes/No
Choose Yes/No
Choose Yes/No
Choose Yes/No
Pushy
Submissive
Is your dog child friendly?
Describe Your Dog’s Activity Level
Choose Yes/No
Choose activity Level
Has your dog been frightened or become unfriendly in the following
circumstances?
Grabbing collar
Hugging
Touching (Awake)
Touching (Asleep)
Choose Yes/No
Choose Yes/No
Choose Yes/No
Choose Yes/No
With other Dogs
With Food
Noises
People
Choose Yes/No
Choose Yes/No
Choose Yes/No
Choose Yes/No
How does your dog exhibit it’s unfriendly/frightened behavior?
Will bite
May bite
Growls
Snaps
Choose Yes/No
Choose Yes/No
Choose Yes/No
Choose Yes/No
Shows teeth
Freezes
Trembles
Moves away
Choose Yes/No
Choose Yes/No
Choose Yes/No
Choose Yes/No
Has your Dog ever….
Been bitten by another dog?
Bitten a person or a dog?
Escaped from your property?
Choose Yes/No
Choose Yes/No
Choose Yes/No
About your dog’s socialization; does your dog….
Socialize with other dogs?
How often?
Share toys with other dogs?
Choose an item.
Choose
Yes/No
Choose Yes/No
Enjoy
playing
with
other
dogs?
Share/eat food
near other
dogs?
Page |5
Previous Services
Has your dog used a daycare center before?
Have you used a groomer before?
Choose Yes/No
Choose Yes/No
Has your dog had a bad experience with either of these?
Please describe these experiences
Your dog’s diet
What type of food do you feed your
dog?
Brand(s) of food
Choose Diet
Enter brand(s) of food
Posh Pooch Daycare
To have a better understanding of your dog’s needs, please indicate the type of services
that you are interested in. These details are used as part of our meet and greet sessions,
where you can discuss our services in more detail.
This application form does not commit you to any ongoing daycare at the Posh Pooch.
Daycare frequency
Half or full day
Choose frequency
Choose
Greet & Meet Assessment
MEET & GREET assessments are conducted between 9.00 pm and 1.00 pm.
We will contact you to arrange a day that suits you best. You and your dog will be required to stay
with us for the first hour, then you can leave your dog with us for the rest of the morning.
Page |6
Terms and Conditions (Please read and sign)
Liability and Health Certification
I confirm that I am the legal owner of my dog and that details provided in the Dog Daycare
Application Form are correct.
I understand that if my dog has a history of aggression, biting or excessive barking, the
Posh Pooch reserves the right to refuse entry to Daycare and that any behavior deemed
dangerous or inappropriate may result in the instant dismissal of my dog.
I confirm that my dog has not had any surgery, been ill with a communicable disease or
other condition within the last thirty (30) days, and has received up-to-date Core and
Kennel Cough vaccinations.
I understand that if any medical problems develop while my dog is in the care of the Posh
Pooch, and I cannot be contacted, I authorize them to do whatever they deem necessary
for the safety, health and wellbeing of my dog and I agree to assume full financial
responsibility for all expenses incurred.
I certify that my dog has not harmed or shown aggressive or threatening behavior towards
any person or any other dog. I understand that I am responsible for any harm caused by
my dog while my dogs attend the Posh Pooch Daycare.
I understand that The Posh Pooch Daycare and their staff and volunteers, will not be
liable for any problems that develop, provided reasonable care and precautions are
followed, and release them of any liability arising from my dog’s attendance and
participation at the Daycare.
Payment /Requirements
I understand that I must pay in advance for casual Full/Half-Day or discounted 5-/10-Day
pre-paid passes.
Reservations are required for Daycare. Cancellation must be made 24 hours before the
start of the Daycare appointment. Cancellation with less than 24 hours’ notice will be
charged at 50% of the full fee.
Page |7
Daycare hours of operation are 7:00 am - 6:00 pm. Half-day care is for 6 hours, from
7:00 am – 1:00 pm and 12:00 pm – 6:00 pm.
I understand that if my dog is not picked up by 6:00 pm, I will be charged a late fee of
$1.00 per minute. If I have not picked my dog up by 7:00pm, the Posh Pooch will arrange
overnight boarding at my expense.
If I purchase a half day service and do not pick my dog up by the end of the session, I will
be charged the full day rate. If I fail to pick up my dog by 6:00pm, additional late fees will
apply as above.
Page |8
Accept Terms and Conditions
I certify that I have read and understand the policies of the Posh Pooch Daycare
Centre as set forth on the preceding pages and that I have read and understand
the conditions, and statements of this agreement.
Enter your Name below
Date
of
application
Signature (to be signed during the
first ‘meet and greet’ session)
Date signed
submission
of
this