Mile High Mutts - Doggie Day Care, Boarding & Grooming

Name:

Address:

City

State

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Zip Code

Mobile Number:

Home Number:

Work Number:

Email Address (so we can send you pics):

Where did you hear about us? We like to reward our referrals!

Are you applying for:

Daycare Boarding

Name:

Phone Number:

Vet's Name:

Vet's Phone Number:

Dog's Name:

Dog's Sex:

Male Female

Spayed or Neutered?:

Yes No

Dog's Breed:

Dog's Color:

Dog's Date of Birth:

January\nFebruary\nMarch\nApril\nMay\nJune\nJuly\nAugust\nSeptember\nOctober\nNovember\nDecember\n 1\n2\n3\n4\n5\n6\n7\n8\n9\n10\n11\n12\n13\n14\n15\n16\n17\n18\n19\n20\n21\n22\n23\n24\n25\n26\n27\n28\n29\n30\n31\n 1995\n1996\n1997\n1998\n1999\n2000\n2001\n2002\n2003\n2004\n2005\n2006\n2007\n2008\n2009\n2010\n2011\n2012\n2013\n2014\n2015\n

Any kids in the household?:

Yes No

Is your dog mouthy or does he nibble you?:

Yes No

Is your dog house trained?:

Yes No

Does you dog bark a lot?:

Yes No

What brand of food does your dog eat?

Does your dog take medications? If yes, what kind and for what?:

Yes No

Does your dog have any past injuries or any current conditions? If yes, what are they?:

Yes No

Does your dog dig?:

Yes No

Is your dog frightened by any noises? If yes, what are they?:

Yes No

Is your dog frightened around anything else?:

Yes No

What happens when you or somebody else tries to take food or toys from your dog?

Does your dog share well? If no, what happens?:

Yes No

What kind of toys does your dog like?

Does your dog get along well with other dogs? If no, what happens?:

Yes No

Does your dog prefer to play with any specific breed or size of dog? Male or Female?

Has your dog had obedience training?:

Yes No

What commands does your dog know?

Would you be interested in taking obedience classes here at the day care?:

Yes No

Does your dog have a bathroom command? If yes, what is it?:

Yes No

Does your dog have sensitive areas on the body? If yes, where?:

Yes No

Where does your dog like to be petted?

How does your dog react to strangers?

Are there any types of people that your dog automatically dislikes or fears? If yes, who/why?:

Yes No

How does your dog react to puppies?

Rate your dog's energy level (1 being very mellow, and 10 being an uncontrollable spaz)

1n2n3n4n5n6n7n8n9n10n

Does your dog show any destructive behaviors when you aren’t at home? If yes, what?:

Yes No

Is your dog aggressive on leash?:

Yes No

Off leash?:

Yes No

How often do you walk your dog?:

Does your dog jump up on you?:

Yes No

On others?:

Yes No

Does your dog growl?:

Yes No

Has your dog ever bitten anybody? If yes, what were the circumstances:

Yes No

Has your dog ever jumped or climbed over a fence? If yes, how high? Why?:

Yes No

Any additional comments?

* I understand that I am responsible for any harm caused by my dog while my dog is attending Mile High Mutts, Inc. Doggie Day Care Centers. I shall indemnify Mile High Mutts, Inc. against any claims made against the corporation or losses or damages of any kind suffered by Mile High Mutts, Inc. as a result of my failure to inform Mile High Mutts, Inc. of any pre-existing condition the dog may have (such as illness or aggression problems.) I understand and agree that in admitting my dog to Mile High Mutts, Inc. the facility has relied on my representation that my dog is in good health and has not harmed or shown aggressive or threatening behavior towards any person or any other dog.

* I understand and agree that Mile High Mutts, Inc. will not be liable for problems, damage, or injury caused by my dog provided reasonable care and precautions are followed by day care staff. I understand that Mile High Mutts, Inc is fully insured. I release Mile High Mutts, Inc. of any liability arising from my dog’s attendance and participation at the daycare. I understand that the day care is a place where animals co-mingle in groups. I understand my animal may be placed in a crate for "time outs" not to exceed twenty minutes, for overnight care or if injured. Squirt water bottles and citronella bark collars are used for correction. In extreme cases dogs may be muzzled for their protection or the protection of others or for excessive barking. I understand that when dogs play in group’s nicks and scratches may occur. Day care staff may or may not notify me immediately. If the injury is not serious staff may feel it is ok to leave the dog till the end of the day and let me know about it when I pick up. If the injury is serious I will be notified immediately.

* I understand and agree that any problem or injury that develops with my dog will be treated as deemed best by Mile High Mutts, Inc. Either my veterinarian or our mobile veterinarian will be contacted in the event of a medical problem that is serious in nature. The Department of Agriculture of Colorado requests that a plan be in place in the event your animal were to become deceased while at the day care. I will be notified immediately of the situation and the body will be taken to Harrison Memorial Animal Hospital or will be held at your request until your arrival.

* I understand that if my dog is left at the day care for a period of three days without contact from the owner this dog will be considered abandoned and necessary steps will be taken to turn the animal over to the proper authorities.

* I recognize that there are inherent risks of illness or injury when dealing with animals. Such risks include, but are not limited to, problems resulting from rough play, food scraps found outdoors and kennel cough(doggie colds).

* I, as the owner, agree to be solely responsible for any and all acts or behavior of my pet while in the care of Mile High Mutts, Inc. If my pet should become ill or seem to be in need of medical consideration, Mile High Mutts, Inc. reserves the right to administer aid and/or to use any available veterinarian. I, the owner, shall pay any expenses so incurred.