Daycare Admission Form Client's InformationClient # Name First Last Date MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneCellWorkEmail Dog's InformationName Breed Age Sex Male Female Spayed/Neutered Yes No Has your dog ever been on agility equipment? Yes No Is your dog potty trained? Yes No Can your dog have treats? Yes No Does your dog play well with Select All male dogs female dogs large dogs small dogs Is your dog possessive with Toys Food Other animals Please explain My dog is... (check all that apply) Allowed to run free in the home Supervised Unsupervised Crated when alone My dog is... (check all that apply) Allowed to run free in fenced yard Supervised Unsupervised Free with shock collar Leash walks only Outside, unleashed, unfenced but supervised Has jumped over fence in yard How high? Requirements for Daycare: All vaccines must be up-to-date within a year and administered by a veterinarian. Vaccines include: Rabies, DPC (Distemper, Parvo, Corona), Bordetella (Every 6 months), Heartworm check, and Fecal check. All vaccination history must be brought by owner upon admission or faxed/dropped off prior to admission. InitialAll pets are required to be on a flea and tick preventative. The Pet Resort recognizes Adv Multi/Nexgard/Comfortis. If your pet is not currently on a flea/tick prevention, a one month application will be applied on admission every month for an additional charge of $25-$35/mo. InitialIf your pet is not picked up by 6pm Monday - Friday or 1pm on Saturday then you will be charged as follows: Regular daycare fee; Overnight boarding fee (based on weight); and bath fee (based on weight) as per hospital policy. First medication administered is $5.00 per day. Each additional medication is $2.00 per day.InitialRough Housing: There is inherent rough-housing play. All animals are watched for rough play and/or aggression, but fights may occur. It is possible (even supervised) for a puncture wound to happen during play session. In the event of a fight/injury we will attempt to contact you before providing any medical attention but will always provide emergency service as necessary if we are unable to contact you. You will be billed accordingly. Please be sure we have a current emergency number on file.InitialEmergency Contact Information:Contact Name First Last PhoneAlternate Contact Name First Last PhoneDaycare Choices: Be Our Guest: $20 All pets will be pampered by our attentive staff and relax in our spacious air-conditioned kennels. They will be provided with outside potty breaks and if your pet has any special needs they can be attended to. Medications, if necessary, will be given upon request of the owner. Add a Spa Bath to either package Pamper your pet with a day at the spa. They will receive a general cleansing bath, curry comb massage, and brushing. They will come home refreshed and ready to relax with you. Weight in pounds Bath Fee 0-10 $28.00 11-25 $30.00 26-40 $32.00 41-60 $33.00 61-80 $35.00 81-100 $45.00 100+ $65.00 All prices are subject to change without notice. Pre-purchase 5 days and receive a 10% discount Pre-purchase 10 days and receive a 15% discountHours of Operation for Daycare: Monday thru Friday: 7am to 6pm Saturday: 7am to | pm Sunday: Closed We are closed for daycare on all major holidays. In the event it becomes necessary for Ashton Animal Clinic to retain an attorney to represent its interests in any matter arising out of or relating to the services provided to client and/or client’s pet (including but not limited to, sums due and owing to Ashton Animal Clinic for services rendered) the prevailing party shall be entitled to recover all of its reasonable attorney’s fees and costs from the non-prevailing party.InitialClient SignatureDate MM slash DD slash YYYY Team Member Like Us On Facebook AppointmentsWe will do our best to accommodate your busy schedule. Request an appointment today! Request Appointment Our Location
