YOUR INFORMATION
YOUR NAME
PHONE NUMBER
ADDRESS ( INCLUDING CITY, STATE)
EMAIL
DOG'S INFORMATION
DOG'S NAME
BREED
GENDER
AGE/BIRTHDAY
WEIGHT
IS YOUR DOG SPAYED OR NEUTERED?
VETERINARIAN NAME AND PHONE NUMBER
DOES YOUR DOG SOCIALIZE WELL WITH OTHER DOGS? HAVE THEY EVER ATTENDED DAYCARE?
DOES YOUR DOG SHOW SIGNS OF SEPARATION ANXIETY?
HAS YOUR DOG EVER BITTEN ANOTHER DOG OR PERSON? PLEASE EXPLAIN.
HEALTH INFORMATION
HAS YOUR DOG HAD ANY ILLNESS IN THE PAST 30 DAYS?
IF YES, PLEASE DESCRIBE:
IS YOUR DOG CURRENTLY ON FLEA/TICK PREVENTION?
IS YOUR DOG CURRENTLY ON HEARTWORM PREVENTION?
PLEASE LIST ANY OTHER CURRENT MEDICATIONS:
IS THERE ANYTHING ELSE WE SHOULD KNOW REGARDING YOUR DOG'S HEALTH?
PLEASE LIST PERSON'S AUTHORIZED TO PICK UP/DROP OFF YOUR DOG:
EMERGENCY CONTACT (NAME AND PHONE NUMBER)
ARE YOU INTERESTED IN DAYCARE, BOARDING OR BOTH?
IS THER ANY OTHER INFORMATION WE SHOULD KNOW ABOUT YOUR DOG?
I (Client), the undersigned owner of my pet, ___________ agree to pay in full and in advance for any and all services rendered by Gnarly Dog Daycare LLC. In the event it is necessary to initiate or institute collection proceedings on the account, Client will be responsible for any and all reasonable attorney’s fees and collection costs. A handling fee of $25.00 will be charged on all returned checks. Client understands that he/she is solely responsible for the actions of his/her pet, and as such, Client agrees to indemnify, release and hold harmless “The Gnarly Dog” and its agents and employees for any personal injury and property damage caused by his/her pet to anyone before, during or after utilizing the services of "The Gnarly Dog." All pets are to be currently vaccinated. Should “The Gnarly Dog”, its agents and employees be exposed to any disease or ailment received from Client’s pet which has not been properly and currently vaccinated, it will be Client’s responsibility to pay all costs and damages incurred by the injured party. In the event that Client’s pet is injured or dies before, during or after utilizing the services of “The Gnarly Dog”, Client agrees that “The Gnarly Dog”, its agents and employees will not be held responsible for such injury or death or any resulting damages or claims, except as such injury or death may be caused by “The Gnarly Dog’s” gross negligence. In no event shall “The Gnarly Dog”, its agents or employees be held responsible for incidental, consequential or special damages in connection with the services of “The Gnarly Dog." Client Agrees that “The Gnarly Dog”, its agents and employees are authorized to perform care or services and to seek emergency care with release from liabilities related to transportation, treatment and expense. Should specified veterinarian be unavailable, “The Gnarly Dog” and its agents and employees are authorized to approve medical and or emergency care (excluding euthanasia as recommended by a veterinarian). Client agrees to reimburse “The Gnarly Dog” for all expenses incurred plus any expenses incurred while attending to this need or any other home/food/supplies needed. “The Gnarly Dog” reserves the right to terminate this contract at any time before or during its term if “The Gnarly Dog”, in its sole discretion, determines that Client’s pet poses a danger to the health and safety of “The Gnarly Dog”, its agents or employees. Client agrees this contract shall be binding for additional future services as described in this contract, permitting “The Gnarly Dog” to accept reservations for services without any additional signed contract or This contract is a full and complete instrument. No other warranties expressed or implied are valid unless stipulated above. I have read this Service Contract for accuracy and understand the contents of this form.
DO YOU AGREE TO THESE TERMS AND CONDITIONS?
YOUR FULL NAME
