TGDS Staff Use Only
Evaluation Date: ________
Application Complete: _____
Liability Waiver Signed: ___
Vaccinations Verified: ____
Please submit the completed Application, signed Liability Waiver and a copy of your pet’s vaccination records.
Customer Information
Name:
Address:
City:
State:
Zip Code:
Home Phone:
Cell phone:
Work Phone:
Relationship:
Phone:
Email Address:
How did you hear about us?
Emergency Contact Information
Name:
Pet Information
Name:
Dog’s breed:
Birthdate (or approx.):
Sex:
Veterinary Clinic:
Phone:
Spayed/Neutered
Veterinarian Seen:
Flea and Tick Preventative used:
How often?
Heartworm preventative used:
How often?
Brand of food:
Allergies:
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General Questions
How old was the dog when you acquired him/her?
Where did you obtain your dog?
How long have you had your dog?
Has your dog been to any obedience classes? If so, when and where?
Has your dog ever attended another daycare? If so, why are you switching daycares?
Why do you want your dog to come to daycare?
How often do you plan on having your dog come to daycare?
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Does your dog…..
Jump on people?
Yes
No
Comments
Pull on leash while walking? If yes,
list any equipment your dog is
accustomed to wearing:
Is your dog used to being in a crate?
Bark in his/her crate?
Bark during play with people or other
dogs?
Chomp your hand while taking a
treat?
Play rough with other dogs?
Nip at people? If so, under what
circumstances:
Know basic commands? Which ones?
Display destructive behavior in your
home?
Share his toys with people and other
dogs?
Eat his own or other dogs’ feces?
Have any strange habits? Explain
Jump or climb out of fences?
Have any health problems such as hip
dysplasia or arthritis?
Have any allergies?
Bark or react to strangers on or off
leash?
Bark or react to other dogs on or off
leash?
Greet strange dogs nicely?
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How is your dog with:
Children
Small dogs
Big dogs
Puppies
Men
Women
Loud noises
Someone taking his toy or food
away
Someone touching his feet
Someone touching his ears
Someone grabbing his collar
Are you….
Willing to work at home on issues
such as jumping, mouthing, rough
play etc. if they arise in daycare?
Willing to enroll your dog in
tutoring sessions during daycare if
necessary?
Comfortable with a Gentle Leader
being used on your dog at
daycare?
Comfortable with your dog
swimming in a kiddie pool during
the summer months?
Able to abide by the pickup time
on a regular basis? (Late fees apply
Good
Yes
Bad
No
Indifferent
Not sure
for all late pickups).
Is there anything else you would like to tell us about your dog?
Page 4 of 5
I, _______________________________hereby certify that my dog, ___________________is in good
health and has not been ill with any communicable condition in the last 14 days. I further certify that my
dog has not harmed or shown any aggressive or threatening behavior towards any person or any other
dog. I have read and understand the following:
1. I understand that I am solely responsible for any harm caused by my dog while my dog is at The
Good Dog Spot, Inc. I herby release The Good Dog Spot, Inc. of any liability arising from my dog’s
attendance in daycare and/or overnight care.
2. I further understand and agree that in admitting my dog to day or overnight care, The Good Dog
Spot, Inc.’s Staff have relied on my representation that my dog is in good health and has not harmed
or shown any aggressive or threatening behavior towards any person or any other dog.
3. I further understand and agree that The Good Dog Spot, Inc. and their Staff and Volunteers, will not
be liable for any problems that develop, provided reasonable care and precautions are followed, and
I hereby release them of liability of any kind whatsoever arising from my dog’s attendance at and
participation in daycare.
4. I further understand and agree that dogs can sometimes receive minor cuts and scratches at daycare
and any problems that develop with my dog will be treated as deemed best by Staff and Volunteers
of The Good Dog Spot, Inc. at their sole discretion, and that I assume full financial responsibility for
any and all expenses involved.
5. I further understand and agree that, in the event of an emergency, The Good Dog Spot, Inc. Staff
will first attempt to contact me, the owner, seconded by an attempt to contact the emergency
contact of record. The Good Dog Spot, Inc. may also contact the veterinarian of record directly, or
an emergency veterinarian, if it is determined that immediate treatment is necessary. The Good Dog
Spot, Inc.’s Staff maintain sole discretion, without liability, in emergency matters. I agree to pay for
all medical treatments received, including transportation to an emergency veterinary facility, promptly
upon picking up my pet.
6. I further understand that all charges are to be paid in advance, or upon pick up on the day of a
scheduled visit. Daycare hours are from 7:00 a.m. to 6:30 p.m. A late charge will be applied after
6:30pm and I agree to pay this charge upon arrival. I further understand that if my dog is not picked
up by 7 pm, my dog will be considered an overnight guest and overnight rates will apply and I agree
to pay this charge, promptly upon picking up my pet.
7. I further understand that if my dog is left at The Good Dog Spot, Inc. for a period of 48 hours
without contact from me, the owner, my dog will be considered abandoned and necessary steps will
be taken to turn the animal over to the proper authorities.
I certify that I have read and understand the policies of The Good Dog Spot, Inc. as set forth on the
preceding pages and that I have read and understand the conditions and statements of this agreement.
Signature of Owner:_________________________________________ Date: ______________________
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