Owner's Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Pet's Name *

What Breed is Your Pet? *

What Size is Your Pet? *

Authorized Individuals *

First

Last

Primary Phone *

Email *

Emergency Contact *

First

Last

Primary Phone *

Authorized Individuals to pick up and/or drop off your dog

What size is your pet? *

Small under 20lbs
Medium 21-50lbs
Large 50lbs+

Does your pet have any allergies or medical conditions? *

Yes
No

If yes, please explain *

Will your dog require any medications to be administered during the time he/she will be attending Day Play? *

Yes
No

Day Play staff cannot administer controlled substance medications.
All medications must be in original containers with clearly labeled instructions.

Has your pet had any coughing, vomiting, diarrhea, or injuries in the last month? *

Yes
No

Have you seen any fleas on your pet? *

Yes
No

Is your pet on flea and tick preventative? *

Yes
No

Is your pet on heart worm/intestinal parasite preventative? *

Yes
No

Does your pet have any physical limitations? *

Yes
No

If yes, please explain

Please note, if your dog has been ill with a communicable or potentially communicable disease within the past 30 days a health clearance signed by a licensed veterinarian must be received before your dog can attend day play. Please do not bring ill (vomiting, diarrhea, eye/ear infections) or injured (sore, limping etc.) dogs to day play.

Does your dog require a meal during the time he/she will be attending Day Play? *

Yes
No

If yes, specify time and amount of food per meal.

Food Options *

Kennel food (Purina EN)
Own food (Please bag food for each meal and label)

PET PROFILE

How long have you owned your dog? *

Has your dog been to a daycare before? *

Yes
No

Is your dog comfortable with strangers? *

Yes
No

My dog typically prefers dogs that are (Check all that apply): *

My dog typically does not prefer dogs that are (Check all that apply): *

Please describe any behaviors exhibited with dogs he/she does not typically prefer: *

Does your dog have any behavior challenges? Check all that apply: *

If other, please clarify *

Please check any behaviors your dog has exhibited past or present. *

REQUIREMENTS

Puppies must be over 12 weeks and on a vaccination program.
All dogs must have been in the home for at least two weeks prior to attending daycare.
All dogs over the age of 8 months must be spayed or neutered
All dogs require up to date vaccinations for rabies, DHLPP, and Bordetella (kennel cough). Proof of vaccination or titer testing is required.
Dogs that are currently ill or injured are not permitted at daycare. Dogs who have recovered from a communicable illness within the past 30 days must provide veterinary clearance to return to day play. Owners certify by signing this application that their dog is in good health.
If your dog incurs veterinary bills during day play you, the legal owner of the animal, must pay those bills at time of pickup. In an emergency, Kittery Animal Hospital reserves the right to administer or seek veterinary care for your dog at its discretion.
Owners certify by signing this application that their dog has no history of aggressive behaviors, threatening or harming any person or animal.
We reserve the right to refuse any dog for any reason at any time.
Pick-ups must be completed by 6:00 PM. Late fees for late pick-ups do apply at a rate of $10.00 for every 15 minutes past 6:00 PM. No exceptions.

WAIVER AND AGREEMENT

Can Kittery Animal Hospital use pictures of your pet on our social media? *

Yes, you can use my pet's photo.
No, please do not use my pet's photo.

I hereby represent that I am the legal owner of the dog(s) described above to use the services provided by Creature Comforts Kittery Animal Hospital *

I have read and understand

I hereby waive and release Creature Comforts Kittery Animal Hospital, it’s employees, owners and agents from any and all liability for any problems that might develop with my dog(s) including, but not limited to sickness, disease, injury, running away and death, while in attendance and participation of services provided by Creature Comforts Kittery Animal Hospital provided that reasonable care and precautions are followed. *

I have read and understand

I understand and agree that in admitting my dog(s), Creature Comforts Kittery Animal Hospital has relied on my representation that my dog(s) is in good health and has not harmed, shown aggression or threatening behavior towards any other person or any other dog. *

I have read and understand

I agree that my dog(s) may be videotaped, photographed and or recorded. Creature Comforts Kittery Animal Hospital shall be the exclusive owner to the results and all proceeds of such media. *

I have read and understand

I have provided the above phone number(s) to reach me in case of emergency, or the name and phone number(s) of an alternate contact person who is able to authorize services if I cannot be reached. In the event of an illness or emergency, Creature Comforts Kittery Animal Hospital will attempt to contact me or my alternate contact at the phone number(s) provided; however, I understand that if I cannot be reached within a reasonable length of time, I authorize Creature Comforts Kittery Animal Hospital to treat my pet however is deemed necessary for his/her health and well-being, and I agree to pay for any and all expenses that may be incurred. *

I have read and understand

Signature *

Clear Signature

Day Play Client Authorization Form