Uptown Play Day Form

Welcome to Uptown Day Play! We are so excited you are considering us for doggy day care, and we cannot wait to meet your pup at Uptown Play Day. Please complete this application to the best of your knowledge and make sure you read and understand the attached policies, release and waiver.

Owner *
Owner
Spouse/Other Owner *
Spouse/Other Owner
Address *
Address
Home Phone (Primary Contact) *
Home Phone (Primary Contact)
Cell Phone (Primary Contact) *
Cell Phone (Primary Contact)
Secondary Contact
Secondary Contact
This is for daily updates and to feature your furry friend on our Instagram stories & feed!
Pet's Name *
Pet's Name
Birthday *
Birthday
Not spayed/neutered (required at 6+months) *
Veterinary Phone Number *
Veterinary Phone Number
Veterinary Address *
Veterinary Address
Vaccinations *
Owner/guardian is required to provide proof of current Rabies, Bordetella, DHLPP and Influenza vaccinations as well as a fecal examination by a licensed veterinarian.
Emergency Contact *
Emergency Contact
Emergency Contact Phone Number *
Emergency Contact Phone Number
Emergency Contact Address *
Emergency Contact Address
How Did You Hear About Us? *
What Are Your primary Reasons for Bringing Your Pet to Uptown Play Day? *
Which Services Are You Looking For? *
I, the undersigned, hereby acknowledge and agree that all the information provided in this application is complete and accurate to the best of my knowledge. I consent to Uptown Veterinary Hospital, LLC and any related entity’s use of such information for all lawful business purposes which may include, but are not limited to, for example, providing Uptown Veterinary Hospital, LLC services to you, operating the Uptown Veterinary Hospital, LLC business, and using data that includes information about you and your pet for marketing and other purposes. I further acknowledge and agree that I have read, understand and agree to all the terms and conditions contained in the Pet Release, Waiver of Liability, Assumption of Risk and Indemnification Agreement, as they may be amended from time to time, which are attached and fully incorporated into this application by reference. I hereby execute this Application and the Agreement for my pet, myself and my heirs, successors, representatives and assigns. I further attest that if I am not the owner or sole owner of the pet(s) for whom this Application has been completed, my signature is sufficient to enter into this Agreement for and on behalf of any other owner or representative. If signing electronically, I hereby agree that my signature will be deemed an original and take the place of my wet-ink signature. If signing in ink, I hereby agree that a true and correct copy of this document may be produced in lieu of the original Application. Should a copy be produced, I understand that it is legally enforceable and does not affect that terms of the Application in any way. By signing the Application, I acknowledge and agree that my pet(s) will be commingling with pets from other families which in the care of Uptown Veterinary Hospital, LLC. If you agree to these terms, please sign Name & Date below
 

Please Click Below to Read:

PET RELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT (THE “AGREEMENT”)

 

For emergencies or
more information:

504.897.4973 (phone)

504.897.4938 (fax)