GUARDIAN 1 INFORMATION full name * Address * City,state zip code * Home phone Cell phone Work phone Email GUARDIAN 2 INFORMATION full name Home phone Cell phone Work phone Person to call in case of emergency, Phone 2nd person Phone If we are unable to reach any of the above contacts, and if we deem it necessary, do we have your permission to bring your dog to a veterinarian? * Yes No YOUR VETERINARIANS INFORMATION Name * Address City,State,Zip Phone number ABOUT YOUR DOG Dogs name * Breed * Gender * Male Female Date of birth Is your dog spayed or neutered? * Yes No will be done At what age were they, or will they be, spayed or neutered? * Does your dog jump 5 foot fences? * Yes No Does your dog get along with other dogs? * Yes No Does your dog have any allergies? Yes No Do you object to us giving your dog snacks or treats? Yes No Please explain any allergies. Are there any restrictions that need to be placed on activities or movements? Yes No Please explain these restrictions. Any other special instructions? When would you like to start? On the first day we ask that you to bring your dog in early as possible. We open at 6:30 AM. This way they can meet the other dogs as they slowly arrive. We have found this is the easiest on new dogs. How did you hear about us? * Drove by and saw us Road sign Referred by a friend Google Yellow Pages Other, please specify below Other, please specify If referred by a friend, who? They get a free day! I certfiy that I have read and understand the rules and regulations set forth and that I have read and understand this agreement. I agree to abide by thr rules and regulations and accept all the terms, conditions anstatemant of this agreement. We require that your dog be vaccinated against the following: Rabies, DHPPCV/DHLPPCV and Bordetellosis (Kennel cough) WE WILL NEED A COPY OF CURRENT VACCINATION CORDS/CERTIFICATES. Before submitting the application please read the terms and conditions of the application as outlined below. This application will only be valid if you check that you agree to the terms and conditions. If you do not check that you agree, your application will be exempted and discarded. AGREEMENT I understand that I am solely responsible for any harm caused by my dog(s) while my dog(s) is/are attending Romp and Roll Dog Daycare. I agree to indemnify, defend and hold harmless, Romp and Roll Dog Daycare, Romp and Roll, INC., it's employees and officers from any and all claims, damages or causes of action arising from my dogs attendance and participation at Romp and Roll Dog Daycare. I further understand and agree that, in admitting my dog(s) to Romp and Roll Dog Daycare, Romp and Roll, INC, Romp and Roll Dog Daycare, it's employees and officers, have relied on my representation that my dog(s) is/are in good health and has/have not harmed or shown aggression or threatening behavior toward any person or any other dog. I also understand and agree that the officers, staff and/or volunteers will not be held liable for any problems that develop, including, but not limited to, injuries, illnesses and fleas. I hereby release them from any liability of any kind whatsoever resulting from my dog's attendance and participation at the Romp and Roll Dog Daycare . I further understand that any problem that develops with my dog(s) will be treated as deemed best by the staff and officers of the Romp and Roll Dog Daycare, in their sole discretion, and that I will assume full financial responsibility for any and all expenses involved, including, but not limited to, veterinary bills. .... * I AGREE I DO NOT AGREE

Romp and Roll online application