Please indicate to which location you are
2293 Delaware (North Buffalo)
431 Ellicott St (Downtown)
2293 Delaware Ave (North Buffalo)
431 Ellicott St (Downtown)
, hereby certify that my
dog (enter dog's name below)
is in good health, is
up to date on all vaccinations including Canine Distemper, Parvo Virus, Bordetella, Leptosporosis and Rabies, has not been
ill with any communicable disease within the last 30 days and is entirely free from fleas, ticks or any other parasite.
Furthermore, I certify that my dog is not aggressive towards other dogs, children or adults. I have read and understand
the following policies:
- I understand that I am solely responsible
for any harm or damage to structure, equipment, other dogs or people caused by my dog while my dog is attending The Puppy
- I understand and agree
that in enrolling my dog to The Puppy Playpen, LLC, our staff have relied on my representation that my dog is in good health
and has not harmed or shown aggression toward other dogs, children or adults.
- I understand that my dog must be treated with a parasite preventative as well as flea
and tick preventative.
- I understand that
The Puppy Playpen, LLC and their staff or volunteers will not be liable for any problems which develop, provided reasonable
care and precautions are followed and I hereby release them of any liability of any kind whatsoever arising from my dog's
attendance and participation at The Puppy Playpen, LLC.
- I understand that any problems which develop with my dog will be treated as deemed best by the staff and volunteers
of The Puppy Playpen, LLC at their sole discretion, and that I assume full financial responsiblity for any and all expense
involved. My veterinarian's name and contact information is as follows:
I certify that I have read and
understand the policies of The Puppy Playpen, LLC as stated in the previous pages and that I have read and understand the
conditions and statements of this agreement including the policies regarding fees, scheduling, my dog's health status
and my dog's behavior towards other dogs, children and adults.
Occasionally, dogs may become ill during their stay with us and will need to be picked up so as not to present a contagion
factor to their puppy playmates. Please provide us with contact numbers below, and indicate the order in which
ABOUT YOUR DOG
My doggy is a: (breed)
He/She is _____ years old! (human years,
I am a Boy
I am a girl
Yes, I am spayed/neutered
No, I am not spayed/neutered
Tell us about your dog.
Please check all that apply!
Good on a leash
Not so good on a leash
His/her Likes/Dislikes are:
other dog's tails
My favorite toys are:
Your Dog's Health!
Please select the appropriate response
I do have allergies
I do NOT have allergies
I am current with all of my vaccinations
Please bring up-to-date record of all vaccinations upon first day of day care, thank you!
I am not current with all of my vaccinations
Please indicate below which vaccinations are not up to date
I do NOT have fleas, ticks, or other parasites
I do have fleas, ticks, etc
I am currently being treated
I currently do NOT have any contagious or infectious disease
I currently DO have a contagious/infectious disease
I am currently being treated:
I know basic obedience commands
I have a problem with mouthiness/biting
I have a problem with barking
I have a problem with jumping
I have a problem with digging
I have a problem with housetraining
I have a problem with (other... please explain)
You should also know that I: