2021 New Client Release Form

How did you hear about us?
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home
Please enter a valid phone number.
Cell 1*
Please enter a valid phone number.
Cell 2
Please enter a valid phone number.
Work
Please enter a valid phone number.
Pets Name*
Dog or Cat*

DogCat
Breed of Pet*
Pet's Weight*
Male or Female*

MaleFemale
Spayed / Neutered*

YesNo
Pets Age*
Is your pet current on rabies shot?*

YesNo
Rabies Expiration Date*

MonthDayYear
Date
Your Veterinarian Name/Location*
Vet Phone Number
Please enter a valid phone number.
Health Conditions

SeizuresArthritisCollapsed TracheaAllergiesDeafBlindHeart ProblemsHip DysplasiaEar InfectionFleas / TicksRecent InjuryPregnant or NursingOpen WoundsHot SpotsSores
Health Conditions - Other
Pet's Behavior

FearfulnessSensitivityAggressive with peopleAggressive with Animals
Although grooming accidents are rare, there is always a minute risk when working on a pet. If an accident occurs you will immediately be notified of the incident via the contact number(s) you list at the top of this form. Grooming equipment is sharp, even though we use extreme caution and care in all situations, possible problems could occur including nicks, cuts, scratches, quicking of the nails, etc. In the best interest of your pet, we request your permission to obtain immediate veterinary care if it becomes necessary. Any veterinary bills resulting from a pet being matted, senior or from a pre-existing or unforeseeable condition will be the responsibility of the pet owner. In many cases this can happen when a pet is over excited, wiggling or moving around . We ask if you happen to arrive before your pet is finished please do not get them too excited while they are on the grooming table, we ask this only for the safety of your pet.
1 Initial - 1) Over all Health and Behavior of Pet: I agree and understand that A Clip Above has relied upon my representation that my pet is in good health, has not injured or shown threatening behavior to any persons or animals, is current on all required vaccinations, is free of parasites and has no open wounds or injuries. *
2 Initial - Aggressive Pets: A Clip Above reserves the right to refuse service, or to stop a groom in progress, if your pet is overly stressed and or may pose a threat to themselves, other pets or staff. We never like to force pets through anything and only do what is comfortable to your pet.*
3 Initial - Parasites A Clip Above reserves the right to refuse service, or to stop a groom in progress if we find ANY amount of parasites(fleas, ticks, lice or botflys) on your pet. Our policy is to put your pup in our comfortable isolation kennel away from other animals to prevent any chance of passing along to other pets. The pet at this time must unfortunately be sent home even if the groom is not finished. If your pet is in the tub we will finish the bath, trim nails and clean ears and charge for a bath and brush as well as a $10 flea/tick bomb to empty the area, disinfect and make the salon ready for the next pets.*
4 Initial - Owner Responsibility: The owner agrees to be responsible and liable for acts of behavior of their pet. This may include, but is not limited to, injury of staff member, injury to pet, injury to another pet(s).*
5 Initial - Grooming Enclosures: I agree and understand that my dog(s)may be placed in grooming enclosures before, during or after grooming.*
6 Initial - Risks to Pet: a) General grooming risks- Extra care will be taken when performing any grooming procedures, however, owner must understand possible reactions such as stress, skin irritation, possible nicks to the skin, or a toe nail taken too short may occur. Additionally, problems uncommon but occasional arise after the grooming visit such as bleeding of nicks, clipper irritation, mental or physical stress. Grooming can also expose a hidden medical problem or aggravate a current one. Owner agrees not to hold A Clip Above responsible for any injuries, which might result from this grooming process. b) Aging and Special Needs Pets: Owner is aware that as a pet ages or if the pet has special medical conditions, the process of grooming may become stressful, both physically and mentally. The stress of grooming may cause latent, unknown, active or inactive conditions such as arthritis, bone, joint or surgical sites to become active or in flamed, and unknown active or inactive heart, kidney, or liver disorders to become active and can result in illness, seizures, or the death of the pet. Although A Clip Above will take exceptional responsible care in the grooming of the pet, owner acknowledges that the stress of grooming may initiate immediate or latent medical problems in your pet. Owner agrees not to hold A Clip Above responsible for reactions to grooming. c) Moles/Skin Lesions/Tumors/Other Skin Irregularities: Because these skin irregularities may protrude from the skin, they are vulnerable to nicks or cuts during the grooming process; owner agrees not to hold A Clip Above responsible for any cuts, nicks or skin reactions/irritations due to grooming process.*
7 Initial - Cancellation & No Show Policy: The policy is as follows; Day before is a 50% charge and Day of is a 75% charge of the estimated grooming fee. I understand and agree that if I fail to show up for my scheduled appointment, need to reschedule, or cancel my appointment the day before or the day of there will be a charge to my card that is on file or I will need to provide the information. I also understand that If I do not pay I will not be able to book any appointments till after my debt is cleared*
8 Initial - Administering Aid: I agree and understand that should my pet become ill or appear in need of medical attention, A Clip Above shall have full discretion in administering treatment and I will pay any and all expenses involved in obtaining the necessary treatment, including, but not limited to, veterinarian visits, medications, examinations and surgery. A Clip Above agrees to make reasonable efforts to contact me should aid be necessary, however, if they are unable to reach me or need to administer aid immediately, A Clip Above may use their discretion and administer aid without contacting me first.*
9 initial - Release of Liability: I agree, understand and hereby release A Clip Above, their owners, staff, partners and volunteers, financially or otherwise, for injuries to my pet, myself, or any property of mine while my pet is participating in services provided by A Clip Above.*
By signing below you acknowledge that you have read, understand and are in agreement with the above statements, policies and procedures.
Clients Name (Printed)*
Clients Signature*

Clear
Date

MonthDayYear
Date

I understand that upon scheduling my first appointment I have to provide credit card information, which will be kept on file with Square, to be used as a form of payment when I reschedule, cancel, or no-show my booked appointment within the cancellation policy window. I also understand that if I choose to not leave my dog(s) for their appointment I will be charged as if it was a no call no show. If my card is to be charged I understand I will be notified of the reason for the fee and the amount charged. *
At A Clip Above we strive for the upmost perfection of every dog and cat groom that leaves the facility. I understand that I can call within 48 hours to have any issues with my groom fixed and/or noted for the next time I come in. *

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