DOGGIE DAYCARE RELEASE FORM Parent's Name* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone*Work Phone*Cell Phone*Email* This is the most efficient way to notify everyone about upcoming events or specials. Emergency Contacts*NamePhone 1Phone 2Phone 3 You will always be our first contact, this is if we cannot reach you.Who is your vet? Name / Clinic Phone*Your DogName* Breed* Birthday* Is your dog spayed or neutered?* Yes No Does your dog jump or climb fences?* Yes No List and allergies your dog has What kind of flea treatment is used on your dog? Special Instructions Is there anything else we need to know about your dog?Where did you hear about us? Friend Google Yelp Internet Facebook Phone Book Current Client Drive By Other Please Explain Emergency ConsentAs owner of the above said pet, I hereby give consent for emergency medical care as prescribed by a duly licensed veterinarian. This care may be given under whatever conditions are necessary to preserve life, limb or well being of my pet. Signature* Reset signature Signature locked. Reset to sign again must be 18 years of age or olderDate* MM slash DD slash YYYY Abbey Animal Hospital Daycare PoliciesDay Care* I agreeAll dogs must complete a temperament evaluation. Abbey Animal Hospital Daycare reserves the right to refuse or to reject any dog that might be a safety hazard to its self or other dogs in our care or staff member. This includes, but is not limited to dogs who are aggressive, anti-social, toy or people possessive, anxious, or physically ill. All dogs 6 months or older must be spayed or neutered to attend day care.Vaccinations* I agreeAll dogs must have current vaccinations against Rabies, Bordetella and DHLPP, and Influenza. Intestinal Parasite Screens are needed every 6 months to ensure parasites are not passed from pet to pet. These services can be done while your pet is here for daycare. Please note: getting a Bordetella vaccination is not a guarantee your dog won’t get kennel cough.Flea Protection* I agreeAll dogs are required to have flea protection. If your dog is found to have fleas, we will administer Capstar at the owner’s expense.Collars and Leashes* I agreeAll dogs must be on leash when entering and exiting Abbey Animal Hospital.Toys and Beds* I agreeYou may not bring your own toys or beds from home. This could cause possessive behavior. We will provide toys and bedding.Food* I agreeIf you want your dog to be fed in daycare, please bring your own food from home. If your dog is BOARDING you can bring your own food or we can feed them our food.Service Fees* I agreeAll fees for services are due when services are rendered. Acceptable forms of payment are care credit, credit cards or cash.Late Fees* I agreeCheck out times for doggie daycare are by 5:30 pm Monday, Wednesday and Friday, and by 6:30 pm Tuesday and Thursday. There will be a $10 late fee for dogs picked up after check out time. Any pet not picked up 10 minutes prior to the close of business will be charged for overnight boarding.Abandonment* I agreeIf you neglect to pick up your pet or contact Abbey Animal Hospital to make arrangements within 5 days, Abbey Animal Hospital may assume that the animal has been abandoned. Abandonment does not release you of your obligation for payment of your bill. You will also be responsible for payment for each day your pet is at Abbey Animal Hospital.Hold Harmless / Release AgreementAbbey Animal Hospital, its owner, employee(s), representative(s) or any other person(s) affiliated with the company shall hereinafter be referred to as “Abbey Animal Hospital.” By signing this form, you or your representative(s) Type dog parent's nameshall hereinafter be referred to as “Parent,” and agree not to hold “Abbey Animal Hospital” liable or sue for any injuries and/or death to your dog(s) Print dog’s namewhile in the care of “Abbey Animal Hospital.” We strive to make the doggie daycare experience fun and enjoyable for all pets. Although, Abbey Animal Hospital screens the dogs for temperament, watches the dogs carefully, and does not take aggressive dogs, day care can be hazardous. They can get rambunctious at times and we cannot be held responsible for injuries and/or death that may occur in and out of the day care. If, in my absence, my pet should become ill, injured or in need of veterinary care, Abbey Animal Hospital has my permission to consult with my veterinarian. If my pet should require immediate care, I hereby give Abbey Animal Hospital permission to provide the needed care for my pet. I understand that I am responsible for all veterinary costs. I hereby declare that my dog has never shown aggression, bitten, injured or killed another dog or person. If my dog does I agree to pay all bills associated with the incident. I hereby declare that my animal has not been exposed to any communicable diseases within the last 30 days, and is fully vaccinated in accordance with Abbey Animal Hospital policy. By signing this form, you acknowledge that you understand and accept the terms and conditions set forth by this agreement. "Parent" Signature* Reset signature Signature locked. Reset to sign again must be 18 years of age or olderPrint Name* Date* MM slash DD slash YYYY