Application Form
Pups Name: ______________ Parent’s Name: ______________________________
Address: __________________________________________________________
Phone (s) Cell: ______________Home: ______________Work: _______________
Email: ___________________________________________________________
Emergency Contact: Name: _______________________Phone: ______________
Pup Information:
Breed: ____________________________Age: _____Sex: ____ Weight: _________
Color: _______________________Spayed/Neutered: _______ Birthday:_________
__________
Health Issues: ______________________________________________________
Behavioral Issues: ___________________________________________________
Vet Clinic: ___________________________________Phone:_________________
Vaccination Due Dates:
DHPP
Rabies
Day/Month/Year
Bordetella
or Titier___________
In the event of an injury and you cannot be reached, do you authorize Pipsqueak Pups to take your dog to the vet
at your expense? Yes _____ NO _____
Is there any other information about your pup that might be helpful to us?
How did you hear about us? ____________________________________________
Signature: ______________________________ Date: ______________________
Consent & Waiver Form
Our goal is to provide your pup with a fun, safe and stimulating social environment. To ensure the safety and health of your pup – as well as
the other pups in our daycare family, we require all our pups and their parents to comply with and agree the following terms and
regulations.
As the legal guardian(s) of _______________________________________, I have read, understood and agreed to all
provisions of this agreement.
1.
I ___________________________ herby represent that I am the legal owner or the agent for the owner of the dog described above
(the “Dog”) to be enrolled in Pipsqueak Pups Daycare Inc.
2.
Pups.
I understand that I am solely responsible for any harm caused by my dog(s) while my dog(s) is/are attending daycare at Pipsqueak
3.
I also understand and agree that in admitting my dog(s), Pipsqueak Pups has relied upon my representation that my dog(s) is/are in
good health and have not harmed or shown aggressive behavior towards any person or any other dog.
4.
I further understand that due to the way that dogs interact with one another, minor cuts and scratches can occur even though the
dogs are carefully supervised at all times.
5.
While my dog(s) is/are in the care and custody of Pipsqueak Pups, if I am unreachable in the event of an emergency, I hereby
authorize Pipsqueak Pups, its agents, and/or representatives to seek immediate veterinary care for my dog. I understand that all costs in
connection with, veterinary, medical or other treatment shall be my responsibility.
6.
I hereby release and agree to save and hold harmless, Pipsqueak Pups, it's directors, officers, shareholders, employees, assistants,
members and agents from any and all liability, claims, suits, actions, loss, injury or damage of any nature or kind, or for any liability, claims,
suits, actions, loss, injury or damage which I or my dog(s) may sustain or which may be caused in any way by my dog(s). I specifically, without
limitation, agree to fully indemnify Pipsqueak Pups for any and all such liability, claims, suits, actions, losses, injury or damage.
7.
I certify that I have read and understand the rules and regulations set forth herein and that I have read and understand this
agreement. I agree to abide by the rules and regulations and accept all the terms, conditions and statements of this agreement and confirm the
truthfulness of the contents of the Application form completed by me.
8.
Please note that although Pipsqueak Pups carefully screens all applicants, occasionally we discover that this is not an appropriate
environment for every dog. Pipsqueak Pups reserves the right to permanently remove a dog from daycare at any time.
9.
In the event that my dog causes injury or death to another dog, or to a person while in the care of, or on the premises of Pipsqueak
Pups Daycare. I indemnity and hold harmless Pipsqueak Pups from any action which may be brought against it, and for any defense settlement
or judgment entered against it resulting from such action of my dog. I also agree that if my dog causes injury to another dog, or to a person
while in the care of and or on the grounds of Pipsqueak Pups, I agree to pay the veterinary and/or medical expenses of the injured dog and/or
person. I will assume all liability for the actions of my dog. I understand that payment is due upon services rendered.
10.
I agree that the dog may be videotaped, photographed, and/ Or recorded and I will be given copies on my request.
Additional Grooming agreement:
There is always the possibility that an accident could occur. Grooming equipment is sharp, even though we use extreme caution and care ALL
situations. Problems that can occur include cuts, nicks, scratches and quicking of nails, etc. In most cases this happens when your pet is
wiggling or moving around. When you arrive at Pipsqueak Pups is very important for you NOT to yell your pets name or let them see you in
case we still have your pet on the grooming table. We make every effort to insure your pet is groomed as safely as possible, but an excited pet
can be a dangerous pet to continue to work on. Once your pet knows that you have arrived it is nearly impossible to finish the grooming
procedure safely.
NAME (S) __________________________________________________________________________________
SIGNATURE(S): __________________________________________________ DATE: ______________________