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Woodbridge, VA 22193
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howl_a_day_inn@yahoo.com
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703-670-2788
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APPLICATION
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Fill out the web form and submit, or download and
fill in the
PDF version. |
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A. Owner information
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| Owner Name |
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| Mailing Address |
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| Phone |
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| Email Address |
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| Emergency Contact Name |
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| Emergency
Contact Phone |
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| People with permission to pick up dog (photo ID required when picking up) (up to three people, separated by commas) |
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| Would you like a daily doggy diary entry on our web page for your convenience? (accessible by viewing our webpage) |
Yes
No |
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Points of interest you want to see
on your dog's doggy diary page
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Eating habits
How well he or she sleeps
Where he or she sleeps
Activities with others
General activities
Photos
Number of walks |
| Other points of interest (please specify)
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B. Dog Information
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| Name |
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| Breed |
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| Sex |
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| Coloring |
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| Weight |
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| Age |
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| License Number |
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| Tattoo/Microchip Number |
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| Toys and/or blankets brought |
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C. Medical Information
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| Dates of last vaccination (all owners must provide proof of vaccination prior to Howladay Inn's accepting the dog) |
Rabies
Bordatella
DHLPP |
| Does your dog have current flea and tick treatments? |
Yes
No |
| Is your dog in good health without any need for medications? |
Yes
No |
| List any any medical
conditions and associated medications/treatments we should
be aware of. |
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| If for any reason your
dog requires professional medical treatment while in our
care is there a monetary limit you would like to place on
the care? |
Yes
No
If Yes enter the amount:
$.00 |
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| Veterinarian's Name |
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| Veterinarian's Phone |
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D. Behavior Information
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| What level of training does your dog have? |
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| Has your dog ever bitten or attempted to bite a human or another dog? |
Yes
No
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If you answered 'Yes,' please describe the circumstances
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| Is your dog aggressive regarding his or her food or toys? |
Yes
No
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If you answered 'Yes,' please explain
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| Does your dog exhibit any behaviors I should know of in advance? |
Yes
No
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If you answered 'Yes,' please explain
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| Has your dog been well socialized with dogs outside your own household? |
Yes
No
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E. Owner Statement
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| I,
, hereby certify that my dog,
, is in good health and has not been ill with any communicable condition in the last thirty (30) days. I further certify that my dog has not harmed or shown aggressive or threatening behavior toward any other person or dog. I agree to the terms and conditions set forth by Howladay Inn, and have read and understand the following:
1.
I understand that I am solely responsible for any harm caused by my dog while my dog
is at the Howladay Inn.
2.
I further understand and agree that Howladay Inn Daycare and Dog Boarding will not be held liable for any problems
or costs which develop providing reasonable care and precautions are followed, and I hereby release Howladay Inn of any liability of any kind arising from my dog's participation at the Inn.
3.
I also understand and agree that any problems,
medical or otherwise, which develop or occur with my dog
while at the Howladay Inn will be treated as deemed best by the Owner of Howladay Inn at their sole discretion and I assume full financial responsibility for any and all expenses involved.
4.
I have read, understand and agree to the
rates and billing
policies of the Howladay Inn. Any questions I have
about the
rates and
billing policies of the Howladay Inn have been answered
to my satisfaction by the staff of the Howladay Inn.
5.
I have read, understand and agree to the
medical care policies of the Howladay Inn. Any
questions I have about the
medical care policies of the Howladay Inn have been
answered to my satisfaction by the staff of the Howladay
Inn.
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| Electronic Signature |
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| Date |
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After you have submitted this application, please print it out, sign it, and bring it with you to your first visit. Thank you!
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