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Go Play! Daycare / Playgroup Evaluation Form
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Client's (Human) Name:
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Email Address:
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Home Phone / Cell Phone:
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Dog's Name:
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Breed:
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Age:
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Dog's Weight:
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Sex:
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Is your dog spayed or neutered?
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Yes
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No
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No, but will be
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Is your dog friendly with other dogs?
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Yes
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No
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If your dog has met a dog he's disliked before please explain the circumstances. What was your dog's reaction?:
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Are there an kinds of dogs your dog automatically fears or dislikes? If so, please explain:
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Is your dog friendly with other people?
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Yes
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No
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If your dog has met a person he's disliked before please explain the circumstances. What was your dog's reaction?:
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Are there an kinds of people your dog automatically fears or dislikes? If so, please explain:
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Has your dog ever participated in daycare before? If so, why are you leaving that daycare?
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Has your dog ever played in large groups of dogs before? If so, how did they do? (Shy, fearful, bold, assertive, etc.)
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Please list your dog's social
experiences:
Please select all that apply
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Please describe your dog's
behavior toward other dogs:
Please select all that apply
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Does your dog have any special needs? (Food, allergies, medicine, etc.)
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What does your dog do when you:
Please select all that apply
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Approach him when he's eating?
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Take toys away?
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Touch his neck or collar?
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Touch him while he's sleeping?
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Please select any problems or
concerns that pertain to your dog:
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Yes
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No
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Does your dog crate well? (No barking, digging, crying, etc. in crate?)
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Has your dog ever growled at, snapped, or bitten a person?
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Yes
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No
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If yes, please explain:
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Is there anything else we should know about your dog?
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What days do you plan on having
your dog attend our program?
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Now, please fill out our Service Agreement Below. The SUBMIT button for both forms will be
located at the end of the Service Agreement Form
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Go Play! Service Agreement
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Pet Owner's Name:
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Home Phone / Cell Phone:
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Address:
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City / State / Zip:
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Emergency Contact Name & Telephone Number:
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Veterinarian Name & Telephone Number:
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Pet's Name:
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Age:
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Breed:
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Sex:
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How did you hear about Go Play?
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Has your pet ever bitten or snapped before?
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Yes
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No
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If so, what were the circumstances?
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Terms & Conditions:
Go Play (hereafter referred to as company), is entrusted to use best judgment in caring for Client’s animal(s). If in the event of
emergency, inclement weather, natural disaster, or other circumstances beyond all control prohibit Company or representative from
caring for animal(s), Company will be held harmless for related consequences.
Company will attempt to assign a qualified person (hereafter referred to as representative) to represent Company and render
services in the event of personal emergency or illness. Client will be notified immediately in such case.
Company will not be responsible for any liability with the animal(s) listed in this agreement. Client is responsible for any deaths, injury
to persons, animals or property, or death or injury to other animal caused by the within named animal(s) in the agreement of this
contract. All claims against Company or representative will be waived.
Client agrees to pay any veterinary costs to animal(s) during time animal(s) are in the care of the Company. If animal(s) become ill or
state of health requires professional attention, the Company in its sole discretion may engage the services of a veterinarian or
administer medicine or give other requisite attention to animal(s).
All animals must be currently vaccinated. If Company or representative is bitten, injured, or exposed to any disease or ailment
received from Client’s animal(s) it is the Client’s responsibility to pay all costs and damages incurred.
Company agrees to use Client’s equipment for animal(s) and is not responsible for faulty, unsafe, damaged, or any damages too
equipment. If Company uses it’s equipment for animal(s), Client agrees to pay equipment fees.
Client understands pet grooming includes the use of sharp tools and clippers. Client understands the difficulty of using tools on an
animal and releases Company of all fault if animal(s) are injured. Client understands the severity and pain associated with a matted
coat and authorizes Company to shave animal(s) if necessary. Client understands there is a risk of clipper/brush burn, and eye, ear,
and skin irritation due to grooming and releases Company of fault.
Company will give an estimate of time(s) for services to be rendered. Client understands this time frame is an estimate only and may
vary due to unforeseen circumstances.
There will be an additional charge for animal(s) who cannot be handled by one person.
Company has the right to refuse service to animal(s) who are overdue on vaccinations, aggressive, barking or acting as a disruption,
emotionally stressed, or unsafe to handle.
PAYMENT POLICIES / FEES:
Company accepts cash, checks, credit cards, and money orders for payment upon completion of services. If any circumstances arise,
leading to additional charges upon an agreed price, Client is responsible for additional charges.
A 10% late fee applies to all charges not paid within 7 days of completion of services. Monthly invoices are due by the 7th day of
the invoice’s next calendar month. A handling fee of $25.00 will be charged for returned checks. In the event it is necessary to
initiate collection proceedings on an account, Client will be responsible for all attorney fees, court fees, and any other costs of
collection.
Animals picked up after hours will be charged a $10.00 late fee.
Dogs over the age of 6 months in our Daycare will be charged a $5.00 clean-up fee for having an accident indoors.
If you pay weekly for services, your payment is due the last day of the week we will see your pet.
If you pay monthly for services, your payment is due the last day of the month we will see your pet.
All grooming, class registration, and products (food, toys, etc.) must be paid for at time of purchase.
If you have not been put of a payment schedule and would like to do so, please ask Company for more details. Only certain
circumstances allow the availability of a payment schedule. A credit card may need to be kept on file for all clients.
DAYCARE / DOG WALKING / SHUTTLE SCHEDULE:
Dog walks will be completed anytime between 11:00am - 4:00pm daily. Schedule requests can be considered, but not promised.
Company has 1/2 time slot only available for daily dog walks. Please be courteous of our time and other clients.
If you have a permanent schedule (the same schedule every week) we need that schedule from you in writing. It will need to
specify what days your dog will attend each week, and be signed by you. This will stay attached to your dog’s card.
If you have a flexible schedule for Daycare (a different schedule every week) we need you to provide us with your schedule for the
upcoming week NO LATER than 6pm on the Friday before.
Please call before dropping your dog off for same-day daycare, as we have had to turn clients away at the door because our
program was full for the day. We hate to do that to you and your dog, but cannot take a walk-in in good conscience when we have
people who called ahead in on a wait list. If we continue to have people just drop off their dogs without calling first, a same-day
daycare fee will apply.
Pet Shuttle Service will be completed between 7:15am - 8:30am, 12:30 - 2:00pm, and 5:00pm - 6:15pm. Company has shuttle
running and is on a tight schedule - please make sure your pet has been fed and gone to the bathroom before we arrive. If your
pet is excessively dirty, foul-smelling, or has an accident in our shuttle, a $10.00 cleaning charge will be applied.
CANCELLATION POLICIES: All cancellations must be confirmed by company by either email or phone. If your cancellation is not
confirmed you will be charged.
Dog Daycare: You must cancel your same-day scheduled daycare by 8:00am or you will be billed $15.00.
Dog Walking: You must cancel your same-day dog walk by 10am or you will be billed in full for the walk.
Pet Sitting: You must cancel your visit at least 2 hours prior to your scheduled visit or you will be billed in full for the visit.
Shuttle Pick-up & Drop-off Service: All shuttle services you must cancel by 7:00am or you will be billed in full for the service.
HOLIDAY / INCLEMENT WEATHER POLICY:
On major holidays (New Year's Day, Easter, Memorial Day, Independence Day, Labor Day, Thanksgiving, and Christmas) we will plan
on NOT seeing your pet unless previously scheduled. Minor holidays we will plan on seeing your pet unless previously scheduled.
It is your responsibility to provide us with all changes in schedule due to the holidays. We need all holiday schedules submitted one
week prior to the holiday.
Company has all rights to close due to inclement weather or other dangerous circumstance. Company will inform all scheduled clients
of said closing in a timely manner. Company has right to refuse all services in cases of inclement weather.
SERVICE AREA: Company's service area includes Arlington, Belmont, Medford, Lexington, and Winchester. Clients outside of
regularly serviced area may be assigned a travel charge. We will notify you if a travel charge applies.
CLASS CREDITS: Class registration is non-refundable. If you miss a class during your paid session, you have a credit to make up the
class. This credit must be used during the next session of class or it will be void.
REWARDS PROGRAM: Available to clients with a permanent schedule only. Not to be used with any other discounts, coupons,
etc. Full-time rewards for clients scheduled 5 days a week in our daycare or walking services. Full-time rewards give 10% off all
products and classes and (1) free nail clipping per month. Nail clipping must be done at our facility at our convenience. Part-time
rewards for clients scheduled 2+ days a week in our daycare or walking services and give 5% off all products and classes.
This contract is binding for initial service agreed upon as well as any subsequent services. This contract is binding for client's current
animals and future animals. All animals in client's care are covered by this contract.
By signing this contract, Client agrees all important information of animal(s) has been released to Company.
I have reviewed this service agreement and agree to the contents of this form.
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Client Name:
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Date:
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By submitting these forms, I agree to the contents of this agreement. I have answered these questions truthfully and
have disclosed all important information regarding my dog. I understand that my dog will not be evaluated unless both
of these forms are completed. Please print out a copy for your records. These are legal and binding forms.
These forms will be kept on file for only 30 days.
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