This application is meant to be filled out once prior to your dog’s playcare evaluation.

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Doggy Play Care Application

A tired pup is a happy pup!



Client's First Name
Client's Last Name
Phone Number
Address
Pet's Name
Pet's Breed
Pet's Birthday, so we can celebrate (include the year)!
Pet's Weight (lbs)
How long have you owned your dog?
Where did you get your dog?
Emergency Contact
Name
Relationship
Phone Number
Veterinarian
Veterinarian Phone Number
Veterinarian Address

Copies of vaccine records must be on file: Distemper, Rabies, Bordetella, Influenza


Additional person authorized for pet pick-up/ drop-off (they may be required to show ID)

Name
Relationship
Phone Number

Dog Behavior Questions

Has your dog ever growled at or bit a person or another dog?
If you answered yes, please describe the incident:
Can you take food away from your dog without growling?
Will your dog share toys with dogs or humans?
Has your dog ever jumped a barrier or fence?
Are there any areas on your dog's body where they DO NOT like to be touched?
Please describe the circumstance:
0 /
Has your dog ever socialized with a large group of dogs?
If you answered yes, in what setting?
Anything else we should know about your dog?
0 /
Do we have permission to post pictures on our social media?

PLEASE READ CAREFULLY.

THIS AGREEMENT INCLUDES A RELEASE OF LIABILITY AND OF LEGAL RIGHTS AND DEPRIVES YOU OF THE RIGHT TO SUE HICKORY PET INN AND/OR ANY RELATED PARTIES. DO NOT SIGN THIS AGREEMENT UNLESS YOU HAVE READ AND UNDERSTOOD IT IN ITS ENTIRETY. SEEK THE ADVICE OF LEGAL COUNSEL IF YOU ARE UNSURE OF ITS EFFECT.

 

CANINE PLAYCARE POLICIES, PROCEDURES AND PLAYCARE RELEASE. WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNIFICATION AGGREEMENT

 

Inconsideration for my dog being permitted to attend HICKORY PET INN (Herein after“HPI” or “Playcare”) for playcare, I agree to all the following policies, procedure, terms and conditions:

 

PLAYCARE REQUIREMENTS: My dog meets the following playcare requirements: he/she has successfully completed the behavioral assessment, is spayed/neutered; is over 4 months of age; is current on all required vaccines and is in good health and free of fleas, ticks and parasites with a copy of the current veterinarian records; is not aggressive or protective of toys; meets all other municipal or state licensure and other requirements; their belongings are all labeled with first and last name. I have completed the canine playcare enrollment application. My dog will enter and exit HPI on leash and collar.  I understand that my dog will be in an indoor dog run from 7am-9am (pre-playtime), 12pm-1pm (afternoon nap), 4pm-6:30pm (post-playtime). Playtime is from 9am-12pm & 1pm-4pm.

 

ACCEPTANCE AND ACKNOWLEDGEMENT OF DAYCARE PARTICIPATION RISK: I fully understand that (a) there are inherent and potential risks involved with interactions between humans and dogs, as well as between dogs and other dogs, which may result in property damage or bodily injury, including permanent disability, sickness or death to human or dog and (b) there may be other risks not known to the owner or staff nor readily foreseeable at this time (Collectively “Risks”) I fully accept and assume all risks and responsibility for all risks, including, without limitation, all loses, costs and damages incurred as a result of me or my dog’s participation in the event.

 

VETERINARIAN LIABILITY AND CARE: I allow HPI to obtain medical treatment for my dog at Hickory Veterinary Hospital, if, in its sole discretion it appears that he/she is ill, injured or exhibits any other behavior that would reasonably suggest that my dog may need medical attention. I AGREE THAT I AM FULLY RESPONSIBLE FORTHE COST OF ANY SUCH MEDICAL TREATMENT PROVIDED TO MY DOG.

 

ABANDONED DOGS: No dog may be abandoned at HPI. HPI follows the Pennsylvania Dog Laws regarding abandonment.  I agree that I will not neglect to pick up my dog from HPI by the time he/she is scheduled to be picked up without providing notification prior to my delay.  I understand that if I abandon my dog at HPI, that HPI will, by default, become the legal owner and guardian of the dog. I understand that I am responsible for any boarding charges incurred during this process. HPI will, in their sole discretion, determine whether to try to rehome and adopt the dog from HPI or will relinquish the dog to an unrelated shelter of their choice. I FULLY UNDERSTAN AND AGREE THAT IF I ABANDON MY DOG AT HPI, I MAY BE UNABLE TO RETRIEVE POSSESSION OF MY DOG AND WILL HAVE NO RECOURSE AGAINST HPI AS PROVIDED BELOW.


 

DUTY OF DISCLOSE: I have disclosed any and all medical or other conditions, included but not limited to personality concerns or behaviors that may affect limit or prevent my dog’s ability to participate in the Daycare or otherwise attend HPI.

 

DAYCARE PARTICIPATION: I understand that dog participation in Daycare is at the sole discretion of HPI and that dogs may be separated from other dogs or asked to leave for reasons in sole discretion of HPI.

 

AGGRESSIVE DOGS: My dog is not aggressive. Although HPI loves all dogs, I understand that aggressive dogs are not permitted to attend HPI playcare. I also understand if my dog acts or exhibits unacceptable behavior he/she will be separated from the playcare group. HPI will use reasonable efforts to consult parent about aggression and ways to address it, however aggressive dogs may be asked not to return to HPI. Such determinations shall be made at the sole discretion of HPI.

 

MY DOG’S FOOD: I understand that HPI does not feed Breakfast, Lunch or Dinner to playcare dogs unless prior arrangements have been made. All food brought must be in a plastic container with a lid and my dog’s first and last name printed on the container.  HPI reserves the right to charge a nominal fee for this service.

 

PHOTO & VIDEO RELEASE. I allow HPI, the owner, employees, directors and agents to use my dog’s name, images and video taken while at HPI in any form, format, for use, at any time, in any media, marketing, advertising, illustration, and trade or promotion materials. I agree that this provision shall be bound on me and all my successors, heirs, legal representatives and assigns.

 

PERSONAL PROPERTY. I agree that HPI shall not be responsible or liable for any lost, stolen or damaged personal property belonging to either me or my dog. I also understand and agree that my dog’s collar may be removed in the Daycare area to prevent injury to any dogs. If my dog causes any damage to HPI Facility or Equipment, I agree to be fully responsible for the full cost of any repair or replacement, depending on what is needed.

 

PLAYCARE FEES. I agree to pay for all playcare fees, services and products with the credit card, cash, or check (HPI does not accept checks from first time clients) at the time I pick up my dog after each visit at HPI or at the beginning of every month with a playcare subscription. I give my full permission for HPI to charge any of the credit card numbers I provided for any unpaid fees, services or products. I further agree to pay the cost of any check or debit charges returned or challenges for to any reason.

 

WAIVER, RELEASE AND INDEMNIFICATION: I HEREBY EXPRESSLY AND FOREVER GENERALLY WAIVE, DISCHARGE CLAIMS, INDEMNIFY, RELEASE FROM LIABILITY, SAVE, HOLD HARMLESS AND DEFEND AND COVENTANT NOT TO USE HPI, ADVERTISERS, OWNERS, EMPLOYEES, VOLUNTEERS AND ANY PARTIES OWNING FROM AND AGAINST ANY AND ALL INJURY, LIABILITY, CLAIMS, LITIGATION, ACTIONS, SUITS, COST, LOSSES, DAMAGES, EXPENSES OR DEMANDS (INCLUDING REASONABALE ATTORNEY’S FEES) OF EVERY CHARACTER WHATSOEVER ON ACCOUNT OF, ARISING OUT OF, RESULTING FROM OR RELATING IN ANY WAY TO (a) ANY ACT OR OMISSION OF THE RELEASE, INCLUDING NEGLIGENCE, AND (b) MY OR MY DOG’S PARTICIPATION IN ACTIVITIES AT HPI, OR OTHERWISE. I FURTHER AGREE TO INDEMNIFY, SAVE AND HOLD HARMLESS THE RELEASE FROM ANY CLAIMS, LITIGATION, ACTIONS, SUITS, COST, LOSSES, DAMAGES, EXPENSES, ATTORNEY’S FEES, INJURIES OR DEMANDS AS THE RESULT OF ANY SUCH CLAIM. I AGREE THAT THIS RELEASE SHE BE BINDING ON ME, MY SUCCESSORS, HIERS, LEGAL REPRESENTATIVES AND ASSIGNS. I ALSO EXPRESSLY AND FOREVER RELEASE HPI FROM ANY DUTY TO PROTECT ME OR MY DOG(S) FROM THE INJURY OF ANY KIND AND AGREE THAT EVEN IF HPI CHOOSES TO IMPLEMENT SAFETY PRECAUTIONS, SUCH ACTIONS SHALL NOT ALTER THE FACT THAT I HAVE RELEASED HPI FROM ANY DUTY TO PROTECT MEOR MY DOG(S).

 

I HAVE READ AND FULLY UNDERSTAND THE TERMS OF THIS PLAYCARE’S POLICIES, PROCEDURES AND PLAYCARE RELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT PERMITTED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID OR UNENFORCEABLE, THAT THE REMAINDER OF THE AGREEMENT SHALL REMAIN IN FULL FORCE AND EFFECTIVE. I AGREE THAT IT IS INTENDED THAT ALL TERMS OF THIS AGREEMENT CONTROL DESPITE ANY PARTICULAR STATUTE OR LAW THAT WOULD OTHERWISE PROTECT ME OR MY DOG(S).

 

I, the undersigned, hereby acknowledge and agree all the information provided in this Playcare Application is complete and accurate to the best of my knowledge. I further acknowledge and agree that I have read and agree to all the terms and conditions in the Playcare Policies, Procedures, Playcare Release, Waiver of Liability, Assumption of Risk and Indemnification Agreement, as they may be amended from time to time, which are included and fully incorporated into this application. I hereby execute this agreement for my dog, myself, my heirs, successors, representatives, assigns and authorized persons. I further attest that if I am not the sole owner or representative of the dog subject to this application, which my signature is sufficient to enter into this agreement for and on behalf of any other owner or representative.

My dog is up to date on their vaccines (Bordetella, Influenza, Parvo and Rabies)
Vaccine Records
Upload
By typing my name here I acknowledge that I have read and agree to all of the above.
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Three Generations of Helping and Healing

Hickory Veterinary Hospital was founded in 1956 as a team of professionals committed to excellence in animal care. Our continued goal is to deliver the highest quality of veterinary medicine to our patients.