Doggie Daycare Registration Form

  • Requirements for Daycare:

    1. All dogs must be current on the following vaccinations: Rabies, DHLPP, & Bordetella
    2. All dogs must show proof of being spayed or neutered.
    3. All dogs must be current and show proof of monthly Flea and Tick Prevention.
  • MM slash DD slash YYYY
  • Or Please administer (circle one)

    1 mo Oral ($22.28)

    3 mo Oral ($55)

    Consent for Daycare: This is an agreement between the pet owner and Countryside Veterinary Hospital.

    1. Owner agrees to pay for all pet care services requested, as well as all veterinary costs for the pet before the pet leaves the facility.
    2. By signing this agreement and leaving the pet with Countryside Veterinary Hospital, Owner certifies that all information is accurate. Countryside reserves the right to deny admittance to Owner’s pet for any reason at any time.
    3. Countryside Veterinary Hospital staff will exercise reasonable care for the pets left at our facility. If group play is provided, Owner recognizes and accepts potential risks involved in such activity. It is agreed that the owner will be responsible for any and all acts or behavior of said pet while it is in the care of our staff. Risks include small lacerations, wounds or joint injury that could require surgery, or even death.
    4. Owner specifically represents that he or she is the sole owner.
    5. Owner specifically represents that the pet has not been exposed to any contagious diseases within a thirty day period prior to check-in. During the period of this agreement, owner also agrees to notify Countryside of any known exposure of pet to a communicable disease and hold pet out of attending daycare until pet is symptom free for a minimum of 30 days or with written veterinary clearance. Owner further agrees that the pet will remain up-to-date on all required vaccines.
    6. Pets may be picked up until 5:30pm Monday-Friday. Pets not picked up by the check-out time will incur additional fees equal to 1 full night of boarding.
    7. If pet becomes ill or injured, or if the animals health requires professional attention, may be seen by one of our Veterinarians at Countryside Veterinary Hospital at the owners expense.
    8. I agree that Countryside Veterinary Hospital is in no way responsible for lost, stolen, or damaged items.
  • I authorize Countryside Veterinary Hospital to use my pet’s and name and photo/video on their website, social media, or other advertisements. I understand that I will not receive compensation for any pictures or videos used by Countryside.

    Assumption of Risk

    I understand that there are certain risks of injury or illness that are beyond the control of Countryside Veterinary Hospital and their staff. By signing below, I hereby acknowledge and agree to the following:
    1. I will not hold Countryside Veterinary Hospital responsible for injuries to my pet while participating in the Doggie Daycare program unless it was specifically caused by a Countryside Veterinary Hospital staff member.
    2.  I will not hold Countryside Veterinary Hospital for any disease that my pet may contract while staying at the facility.
    3. I will not hold Countryside Veterinary Hospital responsible for any problems associated with anything my pet may ingest while staying at the facility.
  • MM slash DD slash YYYY