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Forms & Waivers
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White Mountain Dawg Barn Registration Form
**Please fill out separate forms for each dog in household**
Client Information
Owner First and Last Name:
First
Spouse or Partner Name (If applicable):
First
Address
Complete Address:
City:
ZIP / Postal Code:
Phone
Cell Phone
Email
Typical work hours:
Emergency Contact Info (friend or family):
Alternate person who may pick up dog:
Special Password:
Pet Information
Dog Name:
First
Dog Age & Birth Date:
Breed:
Weight:
Check One:
Male
Female
Check One:
Spayed
Neutered
Unaltered
Valid Tag or License #:
Microchip or Tattoo Number:
Pet Health ( Please attach a photocopy of immunization record )
Dog has received complete immunizations for (check all):
DHLPP
Bordetella (Kennel Cough)
Rabies
Select All
Name and phone number of vet:
Clinic Name:
Medical Conditions:
Allergies:
Has had flea/tick prevention:
Yes
No
Has had heartworm prevention:
Yes
No
Physical Limitations (sore back, hip dysplasia, etc.):
Insured?
Name of Company:
Pet Background
Previous obedience training:
Interested in further training?
Previous daycare experience:
Previous overnight boarding experience:
What is the most consecutive nights dog has been boarded:
Is dog crate-trained?
Yes
No
Is dog crated when left alone?
Yes
No
Is dog used to a routine at home?
What time is first out?
Last Out?
Does dog enjoy walks/hikes?
Yes
No
Is dog leash trained?
Yes
No
Any sensitive spots?
How long have you owned this dog?
How does your dog react to new dogs he or she meets?
Dog is afraid of:
Dog’s preferred reward:
Favorite toys:
Favorite games:
Other notes:
Pet Behavioral Challenges
Biting or growling at people (explain)
Aggressiveness with other dogs (explain)
Aggressive with/fearful of children (explain)
Behavioral Challenges
Shyness
Jumping on people
Jumping over fences
Chewing or digging
Chasing small animals
Escaping out an open door
Excessive pulling on leash
Pulling out of leash
Running away
Other
Select All
Feeding
Current feeding schedule:
Feeding instructions (time, amount):
Preferred brand:
Treats okay?
Yes
No
Any food/treat dog may NOT have?
Daycare Goal?
What is your daycare goal (if applicable): Socialization Exercise Work on Separation Anxiety or Other:
How did you hear about us?
Google Search
Social Media
Referral
Word of Mouth
Online Review
Other
Comments
This field is for validation purposes and should be left unchanged.
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X
MEDICAL RELEASE FORM
This is a required form for all White Mountain Dawg Barn participants receiving services. First and foremost, the safety and well-being of your dog(s) is of the highest importance. Ensuring that your pet remains safe and well cared for is our first responsibility and as such we take it very seriously. We do our best to have our pet parents screen for pre-existing health conditions; however, some factors may be beyond our control. If a medical emergency arises while a pet is at our facility or participating in a service that we provide it is imperative that we are immediately able to get them medical treatment at the closest available facility. We will call ahead to the veterinary offices in closest proximity geographically to us to ensure they can handle the emergency present. Your pet will be rushed to the closest available facility for treatment, and you will be notified. We notify the owner after we have secured a medical treatment center for the animal to avoid delays. Our goal is to get your pet medical attention as quickly as possible. For that reason, it is a requirement to have our pet parents sign this form.
I acknowledge that WMDB is not trained in veterinary care and cannot diagnose/determine/recognize illnesses/Injuries that are occurring/have occurred/will occur with my dog(s), therefore I hold WMDB harmless and not liable for any medical problems my dog(s) have acquired. I understand that in the event of a medical emergency that White Mountain Dawg Barn, at its sole discretion, deems to need the immediate attention of a licensed veterinarian, I authorize White Mountain Dawg Barn to seek medical attention at the closest available veterinary facility. I further agree that I am financially responsible for any medical treatment my pet(s) receives because of a medical emergency while attending services provided by White Mountain Dawg Barn.
Signature of Owner:
Date:
(Required)
MM slash DD slash YYYY
Printed Name:
(Required)
Comments
This field is for validation purposes and should be left unchanged.
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Owner Agreement
White Mountain Dawg Barn LLC
This agreement shall apply to all boarding and/or daycare visits by your dog to White Mountain Dawg Barn.
I represent that I am the legal owner or authorized by the owner of the dog(s) described on the application.
I represent that my dog(s) is in good health, is currently on all required vaccination for Canine Distemper, Rabies, and Bordetella (Kennel Cough). Is free of fleas, ticks and lice (also on prevention) and has not been ill within the last 30 days.
I understand that while my dog(s) is fully vaccinated, that vaccines are not guaranteed and there is a small risk that my dog(s) may contact a contagious disease or illness. I agree that should this occur, I am responsible for my own pet’s care, medical attention and costs.
I release WMDB, its staff, owners and any representatives from any and all liability which I or my dog(s) may suffer including but not limited to injury, sickness, damage, or death resulting from participation in daycare and boarding.
I understand that although all dogs are fully supervised, incidents of injuries may occur from playing with other dogs, which includes but not limited to bites, scrapes, scratches and sprains.
I represent that my dog(s) is social and has not harmed or shown threatening behaviors towards any person or other dog. I understand the WMDB reserves the right to remove my dog from the play area and place my dog(s) in a separate holding area should my dog(s) display and unwanted behaviors.
I allow WMDB’s staff to contact my veterinarian should any injuries or illness require medical attention. I agree that I am solely responsible for any medical expenses acquired for my dog(s).
In the event that I or my authorized contact cannot pick up my dog(s) at the agreed pick-up time, I authorize WMDB to provide additional overnight and daycare services at my expense.
I understand that if I pick up my dog(s) after 11am on the pick-up date from a boarding stay that I will incur a daycare charge.
With my signature below, I certify that I have read and understand the agreement and waivers. I agree to abide by the regulations and accept all terms and conditions as set out.
Signature of Owner:
Date:
(Required)
MM slash DD slash YYYY
Printed Name:
Dog(s) Name(s):
(Required)
Name
This field is for validation purposes and should be left unchanged.
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X
