The Groom Room Pet Salon Burnaby LTD
DOG DAY CARE APPLICATION/ASSESEMENT FORM
OWNER INFORMATION
Date: ________________________
Client Name: _________________________ Email: __________________________________________
Home/Work Phone: _______________________________ Cell Phone: ___________________________
Address: _____________________________________________________________________________
PET INFORMATION
Dog’s name: ________________________ Age: ________Breed:________________________________
MALE/FEMALE
Spayed/Neutered: YES / NO
Veterinarian: ______________________________
Address: _____________________________________________________________________________
Health Issues if there is any: ______________________________________________________________
Behavior Issues: _______________________________________________________________________
Does your dog have pet insurance? YES / NO
Plan# if yes _________________________________
Is your dog on a flea treatment? __________________________________________________________
Is your dog up to date on vaccinations such as Rabbies, Bordetella and Distemper? __________________
PLEASE ANSWER THE FOLLOWING QUESTIONS:
Is your dog possessive of toys? ____________________________________________________________
Does your dog eliminate on leash? _________________________________________________________
Does your dog eliminate on going out on Grass or Asphalt or Any surfaces? ________________________
Is your dog aggressive with other dogs/people? _______________________________________________
PLEASE NOTE: To ensure the safety of your pet and others, the dog’s temperament must first be
assessed by our staff before being accepted to daycare.
CAUTION: AGGRESSIVE dogs will not be accepted to daycare. We have all the rights of not taking
aggressive dogs to the daycare for your own dog and other’s safety.
PLEASE READ AND SIGN: I have read the above questions and hereby state that the answers are true
and correct. I also acknowledge that my dog is in good health without illness or injury upon acceptance to
daycare.
Signature of Owner: ______________________________________ Date: _________________________
The Groom Room Pet Salon Burnaby LTD
DOG DAY CARE APPLICATION/ASSESEMENT FORM
I, ___________________________, hereby certify that my dog(s): ______________________________
is/are in good health and has/have not been ill with any communicable condition in the last 14 days. I
further certify that my dog(s) has/have not harmed or shown aggressive threatening behavior towards any
person or any other dogs. I have read and understand the following:
1. I understand that I am solely responsible for any harm caused by my dog(s) while my dog(s) is/are
attending The Groom Room Burnaby Daycare.
2. I further understand and agree that in admitting my dog(s) to daycare, the staff haa relied on my
representation that my dog(s) is/are in good health and has/have not harmed or shown aggressive
or threatening behavior.
3. I understand and agree that dogs can sometimes receive minor cuts and scratches at daycare and
any problems that develop with my dog(s) will be treated as deemed best by the staff of The
Groom Room Burnaby.
Fees: fees are payable in cash or debit/credit cards and are due at the time of pick up. Monthly
package options are available. Late pick up: 5 minute grace period, and there will be $1/per minute
charge with no exception.
I agree to all the policies and rules made by The Groom Room Pet Salon Burnaby LTD and certify that I
have read and understand the policies and conditions of daycare. I authorize their staff to take care of my
dog(s) and I have read the above-stated provisions, and agree to accept those responsibilities.
Signature of Owner: ___________________________________________________
Date: _______________________________________________________________