Daycare Application

Please Answer All Questions

Owner Information

Full Name

First Name

Last Name

Phone Number

Address

Country

Street Address (Line 1)

Street Address (Line 2)

City

Emergency Contact Name & Phone Number

Veterinarian Name & Phone Number

List Authorized Individuals for Dog Pick-Up/Drop-Off

Dog Information

Name

Breed

Gender

Age

Weight

Health & Behavior

Is your dog spayed or neutered? YesNo

Does your dog socialize well with others? Has your dog attended daycare before?

Does your dog experience separation anxiety?

Has your dog ever bitten another dog or person? If yes, please explain:

Is your dog up to date on rabies, distemper, and kennel cough vaccines? (Proof required via email:
[email protected]) YesNo

Has your dog experienced any illness in the past 30 days? If yes, please explain:

Is your dog currently on flea & tick prevention? YesNo

Is your dog currently on heartworm prevention? YesNo

List any current medications

Any additional information we should know about your dog?

I, , the undersigned owner of the pet,agree to pay in full and in advance for all services provided by Paws on Main LLC. If it becomes necessary to pursue collection proceedings.

I acknowledge that I am solely responsible for the actions of my pet. Therefore, I agree to indemnify, release, and hold harmless Paws on Main, including its agents and employees, from any personal injury or property damage caused by my pet before, during, or after utilizing Paws on Main’s services.

All pets must be current on their vaccinations. If Paws on Main, its agents, or employees are exposed to any disease or illness from my pet due to lack of proper vaccination, I accept full responsibility for covering all related costs and damages incurred by the affected parties.

In the event that my pet is injured or dies before, during, or after receiving services from Paws on Main, I agree that Paws on Main, its agents, and employees will not be held liable, except in cases where gross negligence by Paws on Main is determined. Under no circumstances shall Paws on Main, its agents, or employees be held responsible for incidental, consequential, or special damages inconnection with the services provided.

I authorize Paws on Main, its agents, and employees to perform necessary care or services for my pet and, if needed, to seek emergency care. I release Paws on Main from any liability related to transportation, treatment, and associated expenses. If the specified veterinarian is unavailable, Paws on Main is authorized to approve necessary medical or emergency care (excluding euthanasia) as recommended by a veterinarian.

I agree to reimburse Paws on Main for all expenses incurred in the care of my pet, including costs related to any additional supplies, food, or home necessities. Paws on Main reserves the right to terminate this contract at any time, before or during its term, if it is determined at their sole discretion that my pet poses a danger to the health or safety of Paws on Main, its agents, or employees.

This contract remains binding for any future services described herein, allowing Paws on Main to accept reservations without requiring an additional signed agreement. This document represents the entire agreement, and no other warranties, express or implied, are valid unless stated above.

I have reviewed and understand the terms of this Service Contract and confirm its accuracy.

Signature

Date