Playcare Application - NEW Luxury Unleashed LLC | Dog Boarding & Day Care In Havre

Playcare Application for New Clients

Thank you for your interest in our PLAYCARE program! Our application is quite detailed, so please allow 15-20 minutes for completion. This information helps us to be able to provide the very best care for your furry friend! Please complete and submit one application FOR EACH DOG. If the application has been successfully submitted, you will receive a CONFIRMATION EMAIL and an invoice. Please contact us if you do not receive an email as this means we did not receive your application! After we receive your vaccination records, we will be in touch to schedule an evaluation to make sure PLAYCARE is a good fit for your dog(s). If, for some reason it is not a good fit, your PLAYCARE fees will be fully refunded. We look forward to meeting you both!

Name(Required)

First Last

Cell Phone(Required)

Name of Spouse/Partner

Spouse/Partner Cell Phone

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you text on your cell phone?(Required)

Yes I text.

No I do not text.

Home Phone (If you have one)

Email(Required)

Other than yourself, your spouse, or your vet, who would you trust with a life or death decision for your pet?(Required)

Relationship to Emergency Person:(Required)

Phone Number of Emergency Person:(Required)

How did you hear about us?(Required)

Google

I've been a client in the past.

Referred by a friend.

Referred by Robin at HL

Social Media

Booth at fair or another event.

From my veterinarian.

Other

Dog Details

How many dogs would you like to enroll in Playcare?(Required)

1 dog

2 dogs

3 dogs

Please note that you must fill out a SEPARATE form for EACH pet; individual forms submitted for multiple pets will not be processed. This is for insurance purposes, so we really appreciate your compliance!(Required)

Got it.

We need your vaccination records from your vet asap.(Required)

I will call my vet and have them either emailed (shannonheggem@gmail.com) or faxed (406) 879-4029.

Dog's name:(Required)

Has this dog ever been in a dog daycare or play group in the past?(Required)

Yes

What breed (or mixture of breeds) is your dog?(Required)

How old is your dog?(Required)

Please select:(Required)

Female Spayed

Female Not Spayed

Male Neutered

Male Not Neutered

Are you planning to:(Required)

Neuter him at some point.

Breed him.

Not sure.

My dog is mostly:(Required)

an inside pet.

an outside pet.

My Dog Is:(Required)

Housebroken & rarely if ever has accidents.

Housebroken but occasionally has accidents.

Mostly outside and is not really housebroken.

Housebroken but can be a leg-lifter in new places (male dogs)!

Not really housebroken yet but is in training.

Using puppy (potty) pads.

Approximate Weight:(Required)

Do you ever take this dog to a dog park?(Required)

No I do not.

Yes I do occasionally.

We make regular visits to dog parks.

Has your dog ever jumped or climbed a fence?(Required)

Yes

Has your dog ever bitten anyone?(Required)

Yes

Please explain, in detail, the circumstances surrounding the bite:(Required)

Is your dog currently under vet care?(Required)

Yes

What is he/she being treated for?(Required)

Name of Your Current Veterinarian:(Required)

Veterinarian's Phone Number:(Required)

Does your dog require medication?(Required)

Yes

How Many Different Types of Medication Daily?(Required)

Just one medication.

Two different medications.

Three or more medications.

Please list each medication, what it is used to treat, the dosage, how many times to administer daily, and how you give it to the dog (in a piece of cheese, etc.):*(Required)

Does your dog have any health problems, allergies, or past injuries?(Required)

Yes

Please explain the medical condition, allergy, or injury:(Required)

Within the last week has this dog:(Required)

Been coughing or hacking

Had diarrhea or an upset stomach

Been scratching more than normal

Had a cut, scrape, puncture, or sore muscles, or been limping

Been treated for fleas or ticks? Or have you noticed any parasites or bugs on the pet?

Acted differently than normal? Lethargic, or low energy

My dog has been acting normally.

Please check all of the above which apply.

My dog chews:(Required)

On anything within reach!

Only on his own toys.

To get out of things, including chain link fencing!

My dog barks when:(Required)

He wants attention.

At the doorbell.

At people walking by.

At loud or strange noises.

When he is left alone.

When he is in a crate or kennel.

I use an anti-bark collar.

Rarely, if ever.

Please check all of the above which apply.

My dog shows aggression:(Required)

Around food.

Other dogs.

Around strangers.

Around children.

In his area/territorial.

When he is fearful.

Never.

Please check all above that apply.

Why do you feel that this dog would enjoy playing with other friendly dogs in a closely-supervised play group?(Required)

Vaccinations and Worming

Vaccination records must be submitted to us DIRECTLY FROM THE ADMINISTERING VETERINARIAN'S OFFICE: we cannot accept a faxed or emailed copy from the pet owner for insurance purposes. To avoid being charged a records-retrieval fee, you must have your veterinarian email a current copy of your vaccination records within 7 days of submitting this application. shannonheggem@gmail.com or fax it to (406) 879-4029.(Required)

I will have the records emailed within 7 days of submitting this application..

I need to have this pet's vaccinations updated, and will have my veterinarian email the updated records when this has been done.

I will pay the extra $15.

For everyone's protection, ALL vaccinations must be administered AT LEAST SEVEN DAYS PRIOR to Playcare.(Required)

I understand this policy and will comply.

Please choose one:(Required)

I have my dog vaccinated by a veterinarian.

I buy the vaccine and vaccinate my dog myself.

need to have my dog's vaccines updated.

I have my veterinarian check titers instead of vaccinating.

Exact date of last Rabies vaccination from a vet:(Required)

Exact date of last Distemper/Parvo combo vaccination from a vet:(Required)

Exact date of last Bordetella (or Kennel Cough) vaccination from a vet:(Required)

Exact date of last canine influenza vaccination from a vet (not required, but highly-encouraged):

Have you had your dog wormed by a veterinarian within the last six months? Many people are unaware that their dogs should be wormed on a regular basis. A quick call to your veterinarian will get you a one-time pill or some powder to mix in with his food! Easy-peasy! We mention this because your pet's ongoing health is important, and we care about our guests!(Required)

My dog is on a heart worm prevention program through my vet.

My dog has been wormed in the last six months by the vet. I will have the vet provide proof along with my vaccination records.

I will have my dog wormed, and will update you when it has been done.

Tell us more...

All of the guests who stay with us are special to their owners and very loved! We would love to know more about your furry friend! What would you like us to know about your buddy that you have not yet shared? We would love to know what makes him or her special to you!!

Legal

GENERAL TERMS: Luxury Unleashed LLC will exercise reasonable care for the safety of your pet and to keep the boarding and Playcare premises safe and secure. Luxury Unleashed LLC's liability for any boarded pet or pet in Playcare will not exceed $25. Pet owner is solely responsible for any property damage or bodily injury inflicted by the animal. Luxury Unleashed LLC cannot guarantee against accidents. We will not be liable for loss or damages to pet’s belongings.(Required)

I have read the above statement, and I AGREE

I have read the above statement, and I DON'T AGREE

VACCINATIONS/HEALTH: All animals must be current on vaccines for Rabies, DHLPP and Bordetella (kennel cough). Vaccination records must be provided to Luxury Unleashed LLC DIRECTLY FROM THE VETERINARIAN prior to Playcare or boarding. (Records may be emailed to shannonheggem@gmail.com. All animals accepted for boarding must be of free of fleas and ticks; Owner will be charged a $100 fee for any animal that is dropped off with parasites, which must be paid before animal will be released. Owner hereby represents that this pet has not been exposed to Rabies, Bordetella, Distemper, or Parvo within the last 30 days.(Required)

I have read the above statement and I AGREE.

I have read the above statement and I DON'T AGREE.

BOARDING REQUIREMENTS: Pets are to be dropped off with nylon or leather collars (choke collars, training collars, flea or parasite collars, and/or harnesses must be removed.)(Required)

I have read the above statement and I AGREE.

I have read the above statement and I DON'T AGREE.

MEDICATION & TREATMENT AUTHORIZATION: Prescription medications must be provided in the original container with the veterinarian’s Instructions, It will be administered as prescribed. Luxury Unleashed LLC is authorized by the owner to seek veterinary advice and care, including but not limited to emergency care, at their discretion and at the owner’s sole expense. Luxury Unleashed LLC will attempt to contact the owner before obtaining this care if possible, but this document serves as full authorization to obtain veterinary care for the pet at the owner’s expense, whether or not owner has been contacted.(Required)

I have read the above statement and I AGREE.

I have read the above statement and I DON'T AGREE.

FOOD and WATER DISHES- PLEASE do NOT bring your pet’s dishes, and please do not put any food in the enclosure or feed the pet when you drop him off. Please initial below.(Required)

PAYMENT TERMS: Owner agrees to pay current Playcare price (as listed on website) and for all specialty services in advance. No cash refunds will be issued for any reason. Access to pet will be denied and pet will not be released until all charges are paid in full.(Required)

I have read the above statement and I AGREE.

I have read the above statement and I DON'T AGREE.

I understand that no one besides myself or my spouse/partner is allowed in the drop-off/pick-up area or kennel to access my pet(s) at any time. I hereby agree that I will not give access to ANYONE ELSE, including my children (not even adult children), relatives, employees, friends, neighbors, other Luxury Unleashed LLC clients, etc.(Required)

I agree.

I do not agree.

Have you or anyone in your household had Covid or flu-like symptoms in the past ten days?

Yes

Both Shannon and Dennis are both VERY high-risk should they contract the flu or Covid. We do not require it, but we would REALLY REALLY appreciate it if you mask up whenever you enter the kennel for tours, and drop-offs and pick-ups.

Got it.

This contract shall be legal and binding for one year from the following date, and will include any and all Playcare and boarding during that period. This contract contains entire agreement, and shall be binding upon heirs, administrators, personal reps or assigns of either party. Any controversy arising from this agreement will be settled by arbitration according the Montana Arbitration Laws, with the expense of such paid by the pet owner, regardless of prevailing party. Today's date:(Required)

We take many photos of your pet(s) while he is with us, and these photos will be used for social media and marketing purposes solely at our discretion. We love sharing these photos with you, the owner as well. Please note that we retain the ownership and distribution rights to these photos. Please enter your initials below.(Required)

You should receive a confirmation email as soon as you submit this application. Sometimes technology fails...so, if you do not get the email, or you do not hear from us within a day, PLEASE send us an email to make sure we received the application! We appreciate all of the effort it takes to fill out this lengthy form...and we WILL respond for sure. Please type your initials below so we know that you have read this and understand!(Required)

ELECTRONIC SIGNATURE: The Electronic Signatures in Global and National Commerce Act (ESIGN) (Pub.L. 106-229, 14 Stat. 464, enacted June 30, 2000, 15 U.S.C. ch.96) is a United States federal law passed by the U.S. Congress to facilitate the use of electronic records and signatures in interstate and foreign commerce by ensuring the validity and legal effect of contracts entered into electronically. By entering my name below as an online electronic signature I understand that by doing this, I agree that this document has been signed and given the same legal status equivalent to a written signature.(Required)

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