Petphoria Kitty/Cat Application Form

We love cats and have designed Kitty City to provide the best boarding experience possible. The team here at Petphoria is excited to provide Kitty City Playground and are thankful for the opportunity to have a comfortable and safe place for your beloved cat.

(Please answer all questions. Please fill out one form for each cat)

Your Name:

Date:

Date

Street Address:

Cell:

Work Number:

E mail Address:

example@example.com

EMERGENCY CONTACT IF WE CAN’T REACH YOU (NAME AND NUMBER of CONTACT)

Please tell us about how you heard about us:

Personal Referral: Please give us their name, so we can thank them with a free night of boarding!

Or, did you find us through

Magazine Referrals Facebook Page Petphoria website

Other:

Name:

Breed:

Age:

How long have they lived with you?

Declawed?

Yes No

Is your cat (check one):

Intact Female spayed/neutered Intact male

Approximate Weight:

Veterinarian/Veterinary Hospital's Name:

Address and telephone number of veterinarian:

Date of most recent visit and results:

Date

Are there any current medical issues we should be aware of? Please be detailed or provide additional information from your vet:

Has your male cat ever been treated for urinary obstruction or blocking?

Yes No

Has your cat ever been treated for a urinary tract infection?

Yes No

Name/brand of Food:

Dry or Canned:

How often do you feed?

Once Daily Twice Daily Free Feed Other

How much food at a time?

Does your cat prefer an open litter box? A covered litter box? Something else?

We use Tidy Cat litter. If your cat prefers or requires another kind or brand, please be sure and bring some with you.

Any Medications to administer while your cat is our guest? If so, please list below:

1.

2.

3.

If more space or information is needed, please feel free to attach any additional paperwork.

Is your cat current on vaccinations? (please check all that apply)

Rabies FVRCP Feline Leukemia (not required to board)

Is your cat current on heartworm prevention and monthly flea and tick prevention?

Yes No

A COPY OF YOUR CAT’S MOST RECENT VACCINATION RECORD MUST BE SENT TO US PRIOR TO YOUR

CAT’S FIRST VISIT TO KITTY CITY Playground.

Please note, Kitty City is a flea free facility. If fleas are found on any boarding cat, a one-time dose of Capstar© will be administered at owner’s expense, or a flea bath administered by our groomer at additional expense, and the cat isolated until fleas are no longer detected.

The answers to the following questions will help us gauge our ability to provide the most appropriate, enjoyable environment for your cat. We know this is extensive, but please answer as completely as possible.

Has your cat ever boarded before?

Yes No

If your answer is yes:

How did you feel about the experience? Please tell us any positive or negative observations.

How did your cat respond?

What led you to look for a new boarding place?

If your answer is no:

How do you expect your cat to respond to the boarding experience? Be nervous? Settle in quickly? If you’re not sure, that’s OK too.

Do you have any concerns about your cat boarding at Kitty City? Please be specific.

Does your cat have any physical limitations we need to know about?

Does your cat have any dietary restrictions or allergies?

Does your cat warm up to new people immediately, rather quickly, or does your cat need some time? When resting, how does your cat respond to a human approaching?

Has your cat ever been aggressive toward humans? Has your cat ever deliberately scratched or bitten a person? Please describe what happened in this situation. Please provide the details of the event. (For example: Did the incident involve a Male, female, or a child? Toys or other possessions? Food? Space, such as a bed, couch, et cetera? Being approached? Being reached for, picked up, or petted

Is your cat comfortable with being picked up, petted, or hugged?

Is your cat afraid of thunderstorms? Does your cat have any other unusual fears or phobias?

Are there any other unusual behaviors you have noticed?

Does your cat enjoy being brushed?

Has your cat ever been bathed? How did he or she respond?

Has your cat ever been to a groomer before? Was that a positive or negative experience? Why?

Both

Is your cat declawed? Front Back

If not, do you trim your cat's nails or use other items to prevent damage to furniture?

Is there any other information we need to know about your cat to give him or her an excellent experience at Kitty City Playground?

1. Petphoria Inc Kitty Playground will endeavor to offer only sound, safe, and responsible care for my cat(s However, I have been told that in order for my dog(s) at attend daycare or boarding that they must be vaccinated for rabies and FVRCP. Further, I am and will remain responsible for the actions of my cat at all times and I hereby agree to indemnify and hold harmless (Petphoria INC ) of any and all claims of illness, injury, expense, costs, or damages caused by the actions of my cat while under (Petphoria INC) care. I have been told by (Petphoria INC) and understand the inherent risks of owning a cat, including but not limited to the risk of cat bites or scratches to myself or others. I recognize that (Petphoria INC) is not responsible for any unintentional errors, omissions, or incorrect assertions. I understand that the recommendation of any other product or service is not a guarantee of my satisfaction with that product or service.

2. I authorize emergency medical care to be provided for my cat(s) by the above-named veterinarian, or an appropriate alternate to be determined by (Petphoria INC)in the event that my regular veterinarian is not available or that closer care is required. I will reimburse (Petphoria INC) for any charges related to emergency care.

I authorize (Petphoria INC) to administer or seek 1st aid and resuscitative care for my cat(s) as determined appropriate by (Petphoria INC)and I agree to indemnify and hold harmless (Petphoria INC) for all and any results thereof. I DO NOT authorize (Petphoria INC) to administer or seek 1st aid and resuscitative care for my cat(s) as determined appropriate by (Petphoria INC) and I agree to indemnify and hold harmless (Petphoria INC) for all and any results thereof.

3. Payment Policy

Payment is due at the time cat(s) is/are picked up from Petphoria Kitty City. Credit cards and cash are accepted for payment.

4. Cancellation Policy

Cancellations are to be submitted at least 24 hours in advance of reservation.

This contract is validated by the signatures below in total and as approval for future services without additional written authorization.

5. Grooming Policy

Any cat that arrives with fleas will be given a dose of Capstar at owner’s expense ($25/dose) or given a flea bath by staff and kept quarantined until fle

Your Name:

Signature

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Date