These forms must be filled out in full, dated, signed, and approved by Dog Nerd Day Care+ staff prior to your dog’s first booking. Forms with incomplete information will not be considered.
MM slash DD slash YYYY
Emergency Contact 1
Emergency Contact 2
The following are the names of individuals that have your permission to pick up your dog from Dog Nerd. Once dogs are released into the care of authorized persons or individuals that Dog Nerd is no longer responsible for the well-being of your pet.
VETERINARIAN CONTACT INFORMATION:
*PLEASE BRING A COPY OF YOUR DOG’S VACCINATION RECORDS FOR OUR FILES*
Do not bring your dog if they are injured or ill (coughing, sneezing, vomiting, diarrhea, eye/ear infections, sore, limping, etc). Do not bring females in season. A full bath is required before bringing a female back to Day Care+ after her season is completed.
Name of Breeder, Shelter, Rescue. Etc.
Let Us Know in Above Box
We will feed your dog, at your request, provided you supply the food.
We will medicate your dog (pills, ointments, supplements) as required, provided you provide the medication and detailed instructions for the administration.
Let Us Know.
CLIENT AGREEMENT/LIABILITY WAIVER
I hereby certify that my dog is in good health and has not been ill with any communicable disease in the last thirty (30) days. I further certify that my dog has not harmed or shown aggressive or threatening behaviour towards any other person or dog.
I have read and understood the following:
1. I understand and agree that admitting my dog to the Dog Nerd Play and Learn program, the staff and other designated individuals have relied on my representation that my dog has not harmed or shown aggressive behaviour towards any other dog or person, and that I am solely responsible for any harm caused by my dog whatsoever, either to other dog(s) or to any human, when my dog is in the care of any Dog Nerd staff or designated individual, whether on the premises of Dog Nerd or elsewhere.
2. I understand and agree that my dog is in all respects healthy and has received all required and customary vaccinations and does not suffer from any disability, illness or condition which could affect his/her or other dogs’ time with Dog Nerd. Dogs arriving with fleas, and/or ticks will we sent home, with no refund given. Dog Nerd reserves the right to refuse services or admittance to any dog.
3. I further understand and agree that Dog Nerd and their staff and designates will not be liable for any problems which develop, provided reasonable care and precautions are followed, and I hereby release them of any liability of any kind whatsoever arising from my dog’s attendance and participation at the Dog Nerd Play and Learn Program.
4. I further understand and agree that any problems which develop with my dog will be treated as deemed best by the staff of Dog Nerd, at their sole discretion, and that I assume full financial responsibility for any and all expenses involved.
5. Dog Nerd agrees to exercise due diligence and reasonable care, and to keep the premises sanitary and properly enclosed. All pets are handled or cared by Dog Nerd staff without liability on Dog Nerd’s part for loss or damage from disease, theft, fire, death, escape, injury or harm to persons other pet(s) or property by said dog, or from other unavoidable causes, due diligence and care having been exercised.
6. I further understand and agree that Dog Nerd is a dog facility and that there are inherent risks of death, injury and illness in any environment associated with live animals. Such risks include but are not limited to death, injury or illness resulting from rough play, airborne or surface contagion, outside food scraps or feces, and other dogs at Dog Nerd, or encountered on the street or in public parks while the dog is under the supervision or care of Dog Nerd.
7. The following are the special conditions that the Dog Nerd shall observe or be aware of when performing services: including behavioural characteristics, handling requirements, and other matters that should be disclosed by the client to Dog Nerd or of which Dog Nerd ought to be aware in connection with the dog when performing services (special conditions):
8. I further understand and agree that should my dog become ill or seem to be in need of medical consideration, Dog Nerd reserves the right to administer aid and/or to use any available veterinarian. I fully agree to pay any expenses so incurred, in addition to other fees incurred or services provided at or by Dog Nerd. If a dog shows signs of an illness, Dog Nerd reserves the right to place the dog in quarantine until the dog is picked up or the solution is remedied.
I represent that I have made full disclosure and have read, and understand, and accept the terms and conditions stated in this agreement and acknowledge that this agreement shall be effective and binding upon the parties.
Owner/Guardian Release Form for Media Use
I, the undersigned, do hereby grant or deny permission to Dog Nerd to use the image of my dog(s) as marked by my selection(s) below. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my dog(s) for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on the Dog Nerd web site.