Owner's Name *

Additional Owner

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email *

Cell # *

(###)

###

####

Work #

(###)

###

####

Other's Authorized For Pick-up *

Emergency Contacts

Name *

Cell # *

(###)

###

####

Name

Cell #

(###)

###

####

Dog Information

Dog's Name

Breed

DOB

MM

DD

YYYY

Sex

Male

Female

Is your dog spayed/neutered? *

Yes

No

Does your dog exhibit any of these behaviors?

Jumps fences *

Yes

No

Escapes from confined areas *

Yes

No

Dog aggressive *

Yes

No

People aggressive *

Yes

No

Food aggressive *

Yes

No

Toy/Object aggressive *

Yes

No

Allows you to remove an object from their mouth *

Yes

No

Does your dog have a bite history, either human or dog? *

If yes please explain. Otherwise please type N/A

Vet/Health Information

Hospital/Clinic *

Veterinarian *

Is your dog on heartworm preventative? *

Yes

No

Is your dog on flea/tick preventative? *

Yes

No

Required vaccination documentation from your veterinarian:

• (DHLPP)Distemper, Hepatitis, Leptospirosis, Parvovirus, and Parainfluenza
• Kennel Cough (Bordetella)
• Rabies (Tag #)

What medications is your dog currently taking?

Do they need to be given it while at daycare?

Yes

No

Any known allergies?

Describe any type of health issues your dog has experienced.

Has your dog been to daycare before?

Yes

No

How did you hear about Agawam Dogworks?

Policies and Procedures

Day Daycare is available Tuesday through Saturday. Drop off is any time after 7AM Tues-Fri and after 8AM on Saturday. Pick up is any time before 5:30 PM Tues-Fri and 4PM Saturday. Late fees on pickup are: $1.00 per minute after pickup time. *

Read and Agree

Evaluation: All daycare dogs must complete a behavior and physical evaluation. Evaluations are free and are by appointment only. During this evaluation, we determine if Agawam DogWorks is the right fit for your dog. *

Read and Agree

Reservations: Reservations are recommended but not required. Reservations can be made through Paw Partner, in person or by calling the store. *

Read and Agree

Daycare Cancellations: We realize life happens and sometimes you are unable to bring your dog on your scheduled day(s). If this happens, please give as much notice as possible. (24 hours please) *

Read and Agree

Leash: For your dog’s safety and for the safety of all patrons to the business, all dogs must be on a leash when arriving or leaving the property and in control of their owners. *

Read and Agree

Right to refuse service: Agawam DogWorks reserves the right to refuse or suspend any and all service to anyone for any reason. Any dog that instigates a fight will no longer be welcome to participate in daycare at Agawam DogWorks. *

Read and Agree

Additional Persons Authorized to Drop-Off/Pick-Up: If you want anyone other than you to pick up your dog, you must specify that person on the intake application. To ensure the safety of your dog, this person is required to present a valid picture identification pick-up. *

Read and Agree

Age and Spay/Neuter Requirements: Puppies must be at least 16 weeks old to participate in our daycare program and must have all of their puppy vaccinations. Dogs must be spayed or neutered by 6 months of age to participate in daycare. *

Read and Agree

Vaccines: Proof of Rabies, DHLPP (Distemper and Parvo) and Bordetella vaccinations are required and must remain current to participate in group play. A negative giardia screening must also be on file with new registrants. Dogs with underlying heart conditions or other conditions which may increase the likelihood of injury to themselves or death are not allowed to participate in daycare.

Read and Agree

Changes: Agawam Dogworks reserves the right to change policies, procedures, services, and adjust rates without notice. *

Read and Agree

Guarantee: We strive to be the best we can be, for you and your dog. If you are ever dissatisfied with any service, please tell us. We will gladly work with you to ensure you are getting the service you deserve. *

Read and Agree

Abandonment: I understand that if I do not pick up my dog at all, Agawam DogWorks will proceed according to guidelines provided by Massachusetts Statute 705.19 Abandonment of Animals by Owner: procedure for handling. I also acknowledge that I will be fully responsible for all attorneys’ fees and associated costs if I abandon my dog. If we cannot contact you with the phone # supplied by you and or emergency #, and if you do not show up within 1 hour after our closing we will contact animal control as an abandoned dog. *

Read and Agree

Photos and Videos: I give permission for Agawam DogWorks to take photographs, and/or videos, and to use the images or videos of my dog in printed material, internet sites, or other promotional or advertising capacities. *

Read and Agree

Release and covenant not to sue: The owner hereby releases, waives, discharges, and covenants not to sue Agawam DogWorks, its principals, officers, employees, volunteers, labors, contractors and agents, all of whom for the purposes of this release are referred to as “releases” for all liability to the owner and the owner’s personal representatives, assignee's and next of kin, for any and all loss of injury to the person’s or property, including the pet of the owner. *

Read and Agree

By signing below, you acknowledge receipt of all and adherence to the above policies *