New Approach Registration Form Please fill out the form below to start the registration process: Your Name Dog's Name Address What Service Are you Interested In ---- Dog Training Dog Daycare Dog Grooming Dog Boarding Home Phone Work Phone Cell Phone Email How did you hear about us? Emergency Contact Name Emergency Contact Phone Emergency Contact Relationship Veterinarian Name Veterinarian Phone Vet Clinic/Practice Name Veterinarian Address Breed (or best guess) Age (e.g 1year, 4months) Sex Approx. Weight Spayed/Neutered? Yes No When? Color Micro chipped? Yes No Where did you get your dog? When did you get your dog? Dog’s age at the time? Is your dog a jumper, climber, escape artist? Please Explain Is your dog a barker? Yes No If so, can you cue him to be quiet? Yes No How? Does your dog have any food allergies? Physical limitations/medical problems your dog has: Is your dog on any medication? Does your dog have any current injuries or incision/sutures/staples? If yes, please describe date, location, reason: Body Checks are performed daily by our attendants. Does your dog have any lumps, warts or growths that we should be aware of? Has your dog coughed, sneezed, wheezed, or exhibited any asthmatic symptoms recently? Is your dog on heartworm preventative? Please provide details below include when it was last given Is your dog on flea/tick control? Please provide details below include which kind and when it was last given What type (and brand) of food do you feed your dog? Has your dog ever been in a daycare setting prior to New Approach? If so, when and where? Has your dog had obedience training? If so, when and where? Which of these best describes your dog (Please circle all that apply)? SUBMISSIVE EXCITED DOMINANT SHY NEUTRAL Additional comments: Has your dog ever played with other dogs off leash? Is your dog frightened of any certain noises or actions? Does your dog have any sensitive areas on his or her body? Please upload vaccination certificate (Must have bordatella vaccine) Please be aware of the inherent risks of dogs interacting in a social play group setting. These risks include but are not limited to: - infectious diseases - minor traumas - cuts and abrasions - bite wounds Should your pet require veterinary care to address any medical issues from participating in this program, you will assume financial responsibility for your pet. Spay and Neuter Policy Acknowledge : New Approach recommends that all dogs be spayed or neutered between 6-8 months of age. To ensure appropriate behavior and safety in daycare, all dogs must be spayed or neutered by 8 months of age. If a dog is exhibiting inappropriate behavior prior to be spayed or neutered while they are under 8 months of age, it will be determined on an individual basis if the dog is allowed to continue to partake in daycare by the daycare team. Any dog over 8 months of age that is not spayed or neutered may not attend our daycare program. Please note that all dogs will require proof of up to date vaccine including the Bordatella vaccine. WAIVER, ASSUMPTION OF RISK AND AGREEMENT TO INDEMNIFY AND HOLD HARMLESS Acknowledge : I UNDERSTAND THAT ATTENDANCE IS NOT WITHOUT RISK TO MY DOG. I HEARBY WAIVE AND RELEASE NEW APPROACH, ANY EMPLOYEES OR AGENTS, AND ASSISTANTS, FROM ANY AND ALL LIABILITY OF ANY NATURE, FOR INJURY OR DAMAGE WHICH MY DOG MAY SUFFER, INCLUDING SPECIFICALLY, BUT NOT LIMITED TO, ANY INJURY OR DAMAGE RESULTING FROM THE ACTION OF ANY DOG OR USE OF, OR PRESENCE UPON PREMISES OF EQUIPMENT; AND I EXPRESSLY ASSUME THE RISK OF ANY SUCH DAMAGE OR INJURY WHILE MY DOG IS ON THE GROUNDS OR THE SURROUNDING AREA THERETO. IN CONSIDERATION OF AND AS INDUCEMENT TO THE ACCEPTANCE OF MY PARTICIPATION IN THIS PROGRAM, I HEREBY AGREE TO INDEMNIFY AND HOLD HARMLESS, NEW APPROACH, THEIR EMPLOYEES, AGENTS, AND ASSISTANTS, FROM ANY AND ALL CLAIMS. SIGNATURE OF OWNER OR AUTHORIZED AGENT (MUST BE OVER 18 YEARS OF AGE): SUBMIT REGISTRATION
