NAME: _______________________________________________________________________________________

ADDRESS: ____________________________________________________________________________________

HOME PHONE: _______________________ MOBILE: ______________________ WORK: ______________________

EMAIL ADDRESS: _______________________________________________________________________________

EMERGENCY CONTACT'S NAME: ____________________________________________________________________

HOME PHONE: _______________________ MOBILE: ______________________ WORK: ______________________

NAME: _________________________ BREED: __________________________ GENDER: ______________________

AGE: _________________________ COLOUR: __________________________ D.O.B.: _______________________

DESEXING CERTIFICATE: _________________________ VACCINATION CERTIFICATE: _________________________

VETERINARY CLINIC: ____________________________________________________________________________

VET'S NAME: __________________________________________________________________________________

TELEPHONE: __________________________________________________________________________________

ADDRESS: ____________________________________________________________________________________

HAS YOUR PET EVER ATTENDED SLEEPOVERS BEFORE? ................................................................................... YES / NO

DO YOU HAVE ANY OTHER PETS? ___________________________________________________________________

IF YES, HOW DO THEY GET ALONG? _________________________________________________________________

DOES YOUR PET HAVE ANY MEDICAL CONDITIONS WE NEED TO KNOW ABOUT? ______________________________

_____________________________________________________________________________________________

IS YOUR PET CURRENTLY ON ANY MEDICATION?  ______________________________________________________

DOES YOUR PET HAVE ANY ALLERGIES OR FOOD RESTRICTIONS? _________________________________________

HAS YOUR PET EVER BITTEN A PERSON OR ANOTHER DOG? ............................................................................. YES / NO

IF YES, WHAT WERE THE CIRCUMSTANCES? __________________________________________________________

_____________________________________________________________________________________________

HAS YOUR PET EVER GROWLED OR SNAPPED AT ANYONE TAKING FOOD OR TOYS AWAY? ............................... YES / NO

DETAILS: _____________________________________________________________________________________

HAS YOUR PET EVER GROWLED OR SNAPPED AT ANOTHER DOG THAT TRIED TO TAKE ITS TOYS OR FOOD? .... YES / NO

DETAILS: _____________________________________________________________________________________ 

HAS YOUR PET EVER SNAPPED AT A PERSON OR ANOTHER PET?...................................................................... YES / NO

DETAILS: _____________________________________________________________________________________

IS YOUR PET OVERLY NERVOUS OR TIMID IN CERTAIN SITUATIONS, E.G. STORMS, VACUUM, ETC.? ................ YES / NO

DETAILS: _____________________________________________________________________________________

HAS YOUR PET EVER JUMPED OVER OR CLIMBED OVER A FENCE? ................................................................... YES / NO

IF YES, HOW HIGH? _____________________________________________________________________________

DOES YOUR PET HAVE ANY OF THESE PROBLEMS:

A. MOUTHING? (CHEWING ON HANDS, CLOTHING) ......................................................................................... YES / NO
B. HOUSETRAINING? ....................................................................................................................................... YES / NO
C. EXCESSIVE BARKING? ................................................................................................................................. YES / NO
D. CHEWING/DESTRUCTIVENESS?.................................................................................................................... YES / NO
E. SEPARATION ANXIETY? ................................................................................................................................ YES / NO

HOW OFTEN DOES YOUR PET SOCIALISE WITH OTHER ANIMALS? _________________________________________

ARE YOU ABLE TO REMOVE THINGS FROM YOUR PET'S MOUTH? ....................................................................... YES / NO

IS YOUR PET FEARFUL OR AGGRESSIVE AROUND OTHER ANIMALS? .................................................................. YES / NO

HOW DOES YOUR PET REACT TO PUPPIES/KITTENS? ___________________________________________________

HAS YOUR PET HAD ANY OBEDIENCE TRAINING? .............................................................................................. YES / NO

WHAT COMMANDS DOES YOUR DOG UNDERSTAND? ____________________________________________________

IS THERE ANYTHING ELSE WE SHOULD KNOW ABOUT YOUR PET? _________________________________________

____________________________________________________________________________________________

DO YOU GIVE PERMISSION FOR TREATS TO BE GIVEN TO YOUR PET? .............................................................. YES / NO

DOES YOUR PET REQUIRE MEALS DURING THE DAY? ....................................................................................... YES / NO
IF YES, PLEASE SUPPLY HIS/HER FOOD TO AVOID UPSET TUMMIES

HOW DID YOU HEAR ABOUT POOCH PLAY RIVERINA? ___________________________________________________

_____________________________________________________________________________________________

DO YOU GIVE PERMISSION TO USE PHOTOS OF YOUR PET ON OUR WEBSITE, FLYERS, BROCHURES, ETC? ....... YES / NO

I AGREE THAT THE INFORMATION I HAVE PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE.

SIGNED: ______________________________________________________ DATE: _________________

PLEASE BOOK AS FAR IN ADVANCE AS POSSIBLE TO AVOID DISAPPOINTMENT.

SPACES AT POOCH PLAY ARE ON A "FIRST COME, FIRST SERVED" BASIS.

ONCE A BOOKING HAS BEEN MADE, ANY UNUSED DAYS WILL STILL BE CHARGED.

Linda
Pooch Play Riverina
Wagga Wagga, NSW

Phone: 0404-048-103  |  02-6928-7577
Email: Pooch Play Riverina

I, _______________________________________ HEREBY CERTIFY THAT MY PET, ____________________________

IS IN GOOD HEALTH AND HAS NOT BEEN ILL WITH ANY COMMUNICABLE DISEASES IN THE LAST 30 DAYS.

I FURTHER CERTIFY THAT MY PET HAS NOT HARMED OR SHOWN AGGRESSIVE OR THREATENING BEHAVIOUR TOWARDS ANY PERSON OR OTHER ANIMAL.

I HAVE READ AND UNDERSTOOD THE FOLLOWING:

1. I UNDERSTAND THAT I AM SOLELY RESPONSIBLE FOR ANY HARM CAUSED BY MY PET WHILE HE/SHE IS ATTENDING POOCH PLAY RIVERINA.

2. I FURTHER UNDERSTAND AND AGREE THAT, IN SENDING MY PET TO POOCH PLAY RIVERINA, THE STAFF HAVE RELIED ON MY REPRESENTATION OF MY PET.

3. I FURTHER UNDERSTAND AND AGREE THAT POOCH PLAY RIVERINA AND THEIR STAFF AND VOLUNTEERS 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 PET'S ATTENDANCE AND PARTICIPATION AT POOCH PLAY RIVERINA.

4. I UNDERSTAND AND FURTHER AGREE THAT ANY PROBLEMS WITH MY PET WILL BE TREATED AS DEEMED BEST BY THE STAFF AT THEIR SOLE DISCRETION.

5. I UNDERSTAND THAT WHILE IN CARE MY PET WILL BE IN THE COMPANY OF OTHER ANIMALS.

I CERTIFY THAT I HAVE READ AND UNDERSTOOD THE TERMS AND CONDITIONS OF ENROLMENT AT POOCH PLAY RIVERINA.

SIGNED: ______________________________________________________ DATE: _________________

PLEASE COMPLETE, PRINT OUT, SIGN AND BRING ALONG ON YOUR FIRST BOOKING

OR CLICK HERE TO DOWNLOAD A PDF VERSION OF THIS DOCUMENT

Linda
Pooch Play Riverina
Phone: 0404-048-103  |  02-6928-7577
Email: Pooch Play Riverina