Kennel Club Boarding Registration Form

Kennel Club Boarding Registration Form

Please fill out the registration form as completely as possible so that we may provide the best possible care for your dog. Complete the registration form separately for each dog staying with us.
Please select which best describes your relationship to the dog

OwnerGuardian
Contact Information
Date

MonthDayYear
Date
Name

First NameLast Name
Primary Email
example@example.com
Alternate Email
example@example.com
Approval

ApprovedApproved: Does not play well with other dogsApproved: Bite riskApproved: Special CareForm not signedIncorrect due date(s)Missing proof of vaccination(s)Denied: Health / Safety concerns
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company name
Organization name
Ministry
Department
Role
Company information
Name
Company Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Who will be responsible for payment of invoices?

MeSomeone else
Billing information
Name

First NameLast Name
Billing Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owners information
Owners Name

First NameLast Name
Owners Email
example@example.com
Owners Phone Number
Please enter a valid phone number.
Owners Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dogs information
Dog's Name
Mixed BreedPurebred
Breed
Breed
Weight (Lbs)
Color
Date of Birth

MonthDayYear
Date
Age
Microchip Number
Sex

FemaleMale
Is {dogsName} Spayed?

IntactSpayedUnknown
Note*

Although we accept intact dogs, females who are in heat will not be accepted. Should a female come into heat during her stay with us. She will be segrigated from the other dogs for the duration of her stay and her booking will be changed accordingly. Additional fees will apply.
Is {dogsName} Neutered?

IntactNeuteredUnknown
Does {dogsName} have a regular veterinarian?

YesNo
Vet clinic name
Vet clinic phone number
Does {dogsName} have pet insurance?*

YesNo
Insurer
Effective date

MonthDayYear
Date
Plan name
Customer Number
Policy Number
Picture of {dogsName}

UploadTake PictureNone available
Upload {dogsName}'s photo (Must be a JPG, JPEG or PNG file no larger than 10MB)

Cancelof
Take Photo
Feeding
Have you been responsible for feeding {dogsName}?

YesNo
Dog food brand
Feedings per day
Cups per feeding
Feeding instructions
Booking
Does {dogsName} urinate or defecate indoors?

YesNo
Note*

Cleaning fees will apply if your dog regulary soils themselves or regularly urinates or defecates indoors.

We do not charge cleaning fees for dogs who have an occasional / infrequent or one time accident.

Cleaning fees are charged on a case by case basis at our sole discretion.
Has {dogsName} ever bitten, attacked or shown aggressive behavior towards people?

YesNo
Note*

for {dogsName}'s safety and the safety of all our guests and staff, we do not accept any dogs who are aggresive towards humans. Please email us at Info@KennelClubBoarding.com, and we will cancel and refund {dogsName}'s booking.
Has {dogsName} ever bitten, attacked or shown aggressive behavior towards other dogs?

YesNo
Note*

for {dogsName}'s safety and the safety of all our guests and staff, {dogsName} should be booked in as a dog who does not play well with other dogs. Please email us at Info@KennelClubBoarding.com, if {dogsName}'s booking needs to be changed.
Has {dogsName} been booked as a dog who does not play well with other dogs?

YesNo
Note*

for {dogsName}'s safety and the safety of all our guests and staff, {dogsName} should be booked in as a dog who does not play well with other dogs. Please email us at Info@KennelClubBoarding.com, if {dogsName}'s booking needs to be changed.
Situations causing aggression

Is there a particular person or type of person (age, sex, uniforms) that {dogsName} is more likely to threaten or bite?

YesNo
Please explain
Is there a particular location or situation where {dogsName} is more likely to become aggressive?

YesNo
Please explain
Please provide any additional information we will need to safely care for {dogsName}.
History
Does {dogsName} have any medical or physical conditions we should be aware of?

YesNoUnknown
Please Explain
Does {dogsName} require any medications during their stay with us?*

YesNo
How many times do medications need to be administered?

Once during stayEvery day
Note*

Charges apply for the administration of all medications which will be added to your booking.
Note*

{dogsName} should be booked as "Special Care Required". Please contact us at Info@KennelClubBoarding.com, if you need to change {dogsName}'s booking.
Medication instructions (Charges apply for the administeration of all medications)
Does {dogsName} have any health concerns to walking on any of the following surfaces? (Select the surfaces that MUST be avoided due to health concerns only. Do not list preferences here)

GrassDirtCrushed stoneTileRiver stoneSandWaterMudConcretePaving stonesNone of the above
Note*

All of the above surfaces exist in or around our facility. although we do our best to avoid any surfaces that {dogsName} is sensitive to. We can not guarentee that {dogsName} will not come in contact with any of these surfaces directly or indirectly. If this is an issue for you or {dogsName}, Please email us at Info@KennelClubBoarding.com, to discuss what we can do to manage {dogsName}'s environmental sensitivities.
Does {dogsName} jump/climb/escape fenced areas?*

YesNo
Note*

Dogs who are a flight risk and previously attempted or succeded in scalling or jumping fences, will only be accepted at our Fourth Line Road location, booked in as "Special Care Required". Be sure to let us know both on your registration form and verbally when you drop your dog off that they are a flight risk. Please email us at Info@KennelClubBoarding.com, if {dogsName}'s booking needs to be changed.
Is {dogsName} permitted to play, socialize or otherwise come in contact with other dogs?

YesNo
Has {dogsName} been booked as either a "special care dog", " dog who does not play well with other dogs" or as an "Aggressive Dog"?

YesNo
Note*

for {dogsName}'s safety and the safety of all our guests and staff, {dogsName} should be booked in as a special care dog or dog who does not play well with other dogs. Please email us at Info@KennelClubBoarding.com, if {dogsName}'s booking needs to be changed.
Has {dogsName} ever been bitten or attacked by another dog, or been abused?

YesNoUnknown
Please explain
Does {dogsName} have any behavioral issues, dietary conditions, or other important information we should be aware of.

YesNoUnknown
Please explain
Note*

All dogs with behavioral issues must be booked in as "Special Care Required". Please email us at Info@KennelClubBoarding.com, if {dogsName}'s booking needs to be changed.
May we take, post and or use pictures of {dogsName}?

YesNo
Pick up
Will you be allowing anyone else to pick up {dogsName}?

YesNo
Authorized for Pickup Name

First NameLast Name
Authorized for Pickup Phone Number
Please enter a valid phone number.
Authorized for Pickup Email
example@example.com
Please attach {dogsName}'s vaccination records

UploadTake a picture
Proof of vaccination
*Note:

Vaccination records must include the following
1. Vet clinic name
2. Veterinarians name
3. Vaccination
4. Due date
5. Dogs name
6. Owners name
Vaccination booklet type records are not accepted as proof of vaccination. If you do not have the vaccination record. please call your Veterinarian, they are usually able to provide the correct document the same day.

We will only be able to accept {dogsName} if we have proof of current vaccination.
Take Photo #1
Take Photo #2
Take Photo #3
Upload proof of vaccination. *multiple files may be uploaded.

Cancelof
File Upload #2

Cancelof
File Upload #3

Cancelof
Vaccinations due dates

Your dog will only be accepted if the following vaccinations are current
Rabies due date

DayMonthYear
Bordetella due date

DayMonthYear
Dapp due date

DayMonthYear
Emergency contact

In case of emergencies and we are not able to contact you, who should we contact.
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Email*
example@example.com
Alternate Emergency contact (optional)

In case of emergencies and we are not able to contact you or your emergency contact, who should we contact.
Alt Emergency Contact Name

First NameLast Name
Alt Emergency Contact Phone Number
Please enter a valid phone number.
Alt Emergency Contact Email
example@example.com
Declaration

Providing false, incomplete or inaccurate infomation may have financial and / or legal implications
I CERTIFY THE ABOVE INFORMATION TO BE ACCURATE AND COMPLETE:

Dog Service Agreement
THIS DOG SERVICE AGREEMENT (this “Agreement”) Dated
MonthDayYear
Date
BETWEEN
Name*

First NameLast Name
Ministry
Department
Role
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
(The “Owner”)
Dogs name*
Breed
Date of birth*

MonthDayYear
Date
Sex*

FemaleMale
(The “Dog”)

and

Kennel Club Gear o/a Kennel Club Boarding
5673 Fourth Line Road, North Gower, Ontario, K0A 2T0
Info@KennelClubBoarding.com

(The “Kennel”)

(Hereinafter referred to as the “Parties”)

IN CONSIDERATION OF the Kennel providing services for the Owner’s dog (the “Dog”) for a set period of time, and the Owner paying the Kennel for the services provided to the Dog, the Parties agree to the following terms and conditions set out in this Agreement.

1.         SERVICES

1.1       Type of Service. The Owner shall identify which type of service the Kennel will provide for the Dog. The types of service are set out on our website: www.kennelclubboarding.ca.

1.2 Change of Service. The Kennel agrees to perform services based on the type of service selected by the Owner. The Kennel reserves the right to immediately change, at its sole discretion, the Dog’s type of service if the Kennel believes it is necessary to protect the health and well-being of the Dog, other dogs and / or staff. The Owner agrees to pay any and all additional costs associated with the change.

1.3       Training. If the dog has been booked for training services. The Kennel will make every reasonable effort to help the Dog achieve training and behaviour modification goals but makes no guarantee of the Dog’s performance or behaviour as a result of providing professional training services. The Owner understands that in order for the Dog to obey commands and improve, the Owner must follow the trainer’s instructions without modification, work with the Dog daily as recommended and constantly reinforce the training being given to the Dog.

2.         PAYMENT

2.1       Price of Service. The Owner agrees to pay the Kennel the applicable rate for the type service as indicated in Article 1.1. The Kennel reserves the right to adjust its rates for services in accordance with Article 1.2 at the discretion of the Kennel, without notice to the Owner, and the Owner acknowledges and agrees to pay such prices as amended.

2.2       Payment Due Date. The Owner will pay the Kennel for all fees and services prior to dropping off the Dog. All training services will be suspended until payment is received. If additional fees are charged during the Dog’s stay, the Owner agrees to pay any and all additional fees within thirty (30) days.

2.3       Late Fees. If the Dog will be picked up after the scheduled date and time, the Owner shall contact the Kennel immediately to make arrangements to extend the Dog’s stay. The Owner agrees to pay the late fees as outlined on the website: www.kennelclubboarding.ca. If the Owner is late for pick-up or drop-off by more than fifteen (15) minutes past the pick up and drop off times, the Owner will have to wait until operating hours to pick-up or drop-off the Dog and the Owner will be charged the daily daycare or boarding rate, whichever applies.

2.4       Medical Costs. The Owner agrees to be fully responsible for any and all medical and/or veterinary costs incurred for the Dog during the time the Dog is in the care of the Kennel.

3.         VACCINATIONS

3.1       Records. The Owner agrees to provide the Kennel with current vaccination records from a licensed veterinarian before the Dog is admitted to the Kennel. The records must include the Dog’s name, the name of the Veterinary Clinic, and the date(s) that all required vaccinations outlined in Article 3.2 were given and are due. The Owner authorizes the veterinarian to release the Dog’s medical records to the Kennel upon its written request.

3.2       Required Vaccinations. All dogs must have current vaccinations against Rabies, Bordetella and Distemper.

4.         HEALTH

4.1       Representations. The Owner specifically represents that the Dog is in good health (or under the care of a veterinarian) and has not been exposed to any parasite or infectious disease of any kind within thirty (30) days prior to boarding.

4.2       Refusal/Return. The Kennel reserves the right to refuse to accept the Dog on arrival or return the Dog back to the Owner for any reason including, without limitation, it appears that the Dog has fleas or ticks, is sick, injured, in pain, “in heat” or that its behavior could jeopardize the health or safety of other dogs or staff.

4.3       Duty to Disclose. The Owner agrees to disclose any and all medical or other conditions of the Dog, including personality concerns or behaviours, any medications, allergies or special care instructions. The Owner understands that the Kennel is relying on this disclosure to provide a safe environment for the Dog, other dogs and staff.

4.4       Medications & Supplements. If the Dog is on medication and/or supplements, the Owner agrees to bring a sufficient supply for the duration of the Dog’s stay along with clear written instructions. If the supply is exhausted during the Dog’s stay, the Kennel will make every effort to procure essential medications only and the Owner will be charged for the quantity purchased as well as a procurement fee.
4.5 Food. The Owner agrees to provide a sufficient supply of food for the Dog for the duration of the Dog’s stay along with clear written instructions. If the supply of food is exhausted during the Dog’s stay, the Kennel will feed the Dog a gastrointestinal or sensitive stomach dog food. The Owner agrees to pay for the quantity purchased as well as a procurement fee if applicable.*

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4.6 Medical Services. If the Dog becomes ill, injured or if the state of the Dog’s health or behaviour suggests the need for medical attention, the Kennel, at its sole discretion, is authorized without the prior consent of the owner, to engage the services of a veterinarian and the Owner consents to all required services at a cost of up to and including $1,500.00 (the “Authorized Amount”). The Owner is fully responsible for the cost of any such medical service. The Kennel will contact the Owner for any medical services that will cost in excess of $1,500.00 prior to approving the service(s). *

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4.7 Emergency Treatment. If a veterinarian determines that emergency treatment, which exceeds the Authorized Amount, is needed to save the Dog’s life or quality of life, and the Kennel is not able to reach the Owner or their emergency contact, the Owner authorizes the Kennel to approve the performance of emergency treatment by a veterinarian. The Owner accepts responsibility for all costs of the treatment.*

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4.8 Euthanasia. If a veterinarian recommends euthanizing the Dog, and the Kennel is not able to reach the Owner or their emergency contact, the Owner authorizes the Veterinarian to euthanize the Dog.*

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4.9 Veterinarian. The Kennel reserves the right to bring the Dog to the veterinarian of its choice and the Owner gives full authority to the veterinarian to discuss with the Kennel any aspect of the Dog’s health.

5. LIABILITY

5.1 Responsibility. The Owner agrees to be solely responsible and liable for any and all acts of the Dog while it is in the care of the Kennel. This includes, without limitation, damage, destruction of property, the transmission of disease and/or the injury or death of another dog or person.
5.2 Risk. The Owner agrees to assume all risk of illness, disease, harm or otherwise to the Dog by allowing the Dog to participate in the services provided by the Kennel including transporting the Dog. The Owner accepts the risk that have the dog at the Kennel may be stressful for the Dog and can lead to fluctuations in weight, changes in behaviour and/or changes in physical or mental health. *

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5.3 Cap on Liability. It is expressly agreed by the Owner and the Kennel that the Kennel’s responsibility and/or liability for any circumstance related to the Dog shall in no event exceed the lesser of: (a) the fair market value of a dog of the same breed and age or (b) the sum of $1,500.00. *

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5.4 Misrepresentation. The Owner accepts all responsibility for damages, injuries and/or loss arising from any inaccurate information provided by the Owner to the Kennel. This includes the Owner’s failure to disclosure accurate and complete information about the health or temperament of the Dog.

5.5 Pick-Up & Drop-Off. The Owner agrees that the Kennel is not responsible for the Dog running away at handoff (pick-up and/or drop-off). The Owner further agrees to pay for any damage or injury to property, people or other dogs that result from the Dog running away at handoff.
5.7 Performance or Service Dog. The Owner warrants and represents that the Dog is not currently,nor will be in the foreseeable future, a “show dog”, competition dog who participates in dog shows and/or in trials. The Owner further represents that the Dog is not currently, nor will be in the foreseeable future, a service or therapy dog. The Owner specifically warrants and represents that no revenue or income is generated, or will be in the future, from the Dog.*

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5.8       Intact. The Dog does not have to be neutered or spayed in order to be accepted at the Kennel but if a female dog becomes “in heat” during her stay, the Kennel reserves the right to charge additional fees and the Owner agrees to pay any and all additional fees. The Kennel will not be liable if the Dog becomes pregnant during the Dog’s stay and the Owner will be responsible for any and all costs associated with the pregnancy.

5.9       Personal Property. The Kennel shall not be responsible or liable for any lost, stolen, or damaged personal property belonging to the Owner and left with or for the Dog.

5.10     Authorized Contact. The Owner shall not hold the Kennel responsible for releasing the Dog to any person the Kennel has been advised by the Owner as authorized to pick-up the Dog.

5.11     Breach. The Owner accepts all responsibility for their actions which are in breach of the terms and conditions of this Agreement.

5.12     Release. The Owner agrees to release, indemnify and hold harmless the Kennel from any and all manner of damages, claims, loss, liabilities, costs, or expenses arising out of or related to the services provided by the Kennel.

5.13     Trainer. The Owner expressly agrees to indemnify and hold harmless any trainer providing services to the Dog and/or the trainer’s agents from any claims, demands, lawsuits, losses, costs or expenses, arising out of or in connection with the provision of training services to the Dog.

6.         ABANDONMENT

6.1       Abandoned. The Owner understands and agrees that in the event that the Dog is left at the Kennel and not retrieved for ten (10) days after its scheduled pick-up date, the Dog will be considered abandoned and will become the property of the Kennel.

6.2       Expenses. The Owner shall be responsible for the charges incurred in respect of the abandoned Dog.

6.3       Liability. The Owner agrees that once the Dog is considered abandoned, the Owner will have no recourse against the Kennel.

7.         OWNERSHIP

7.1       The Owner specifically represents that they have care and control of the Dog.

8.         GOVERNING LAW

8.1       This Agreement will be constructed in accordance with and be governed by the laws of the Province of Ontario.

9.         ENFORCEMENT

9.1       The Owner will be liable for any and all costs, expenses and expenditures involved in enforcing this Agreement as a result of any default by the Owner and will be paid to the Kennel immediately.

10.       BINDING EFFECT

10.1     This Agreement will pass to the benefit of and be binding upon the respective heirs, executors, administrators, successors and permitted assigns of the Owner and the Kennel. The Owner waives all rights to protest and notice of protest for this Agreement.

11.       AMENDMENT

11.1     Any amendment(s) or modification(s) to this Agreement must be agreed to in writing and signed by both the Owner and the Kennel.

12.       SEVERABILITY

12.1     The provisions contained in this Agreement are intended to be read and construed independently of each other. If any provision of this Agreement is held by a court of competent jurisdiction to be invalid or unenforceable, in whole or in part, the remaining provisions shall in no way be affected, impaired or invalidated and shall remain in full force and effect.

13.       GENERAL PROVISIONS

13.1     Headings & Subheadings. The headings and subheadings in this Agreement are inserted for the convenience of the Parties only and shall not be considered when interpreting or construing this Agreement.

13.2     Counterparts. This Agreement may be executed in any number of counterparts, which may be exchanged by facsimile or electronic transmission, each of which shall be deemed an original for the purposes of execution. All executed counterparts taken together shall constitute one agreement.

13.4     Accuracy. The Owner certifies the truthfulness and accuracy of all information provided to the Kennel.
13.5 Due Diligence. The Owner acknowledges having read the Agreement in its entirety and understands and accepts its effect.*

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13.6     Voluntariness. The Owner acknowledges having signed this Agreement freely and voluntarily without any inducement, assurance or guarantee.

14.       ENTIRE AGREEMENT

14.1     Agreement. This Agreement constitutes the entire agreement between the Parties and there are no further items or provisions, either oral or otherwise. This Agreement supersedes and cancels all prior representations, promises or agreements, whether oral or in writing, between the Parties.

14.3 Registration Form. The Owner certifies having truthfully filled out the Kennel’s Registration Form.

15.       VALIDITY

15.1     This Agreement will remain in effect for this and any future services for the Dog brought to the Kennel

IN WITNESS WHEREOF the Parties have duly executed this Agreement.
Owner*

Clear
Dated this day*

MonthDayYear
Date
KENNEL CLUB GEAR INC.

o/a KENNEL CLUB BOARDING
Per:

I have authority to bind the Corporation.
Should be Empty:

	growled	attempted to bite	bitten
Petting/handling/restraint:
Eating food or treats
Chewing toys/stolen objects:

	Yes	No
Household members?
Visitors?
Towards people when off property / away from home?
Other animals?
Has your dog ever bitten another animal hard enough to break skin or cause injury?
Has your dog ever bitten a human hard enough to break skin or cause injury?

Kennel Club Boarding Registration Form

Contact Information

Company information

Billing information

Owners information

Dogs information

Note*

Feeding

Booking

Note*

Note*

Note*

Note*

Situations causing aggression

History

Note*

Note*

Note*

Note*

Note*

Pick up

Proof of vaccination

Vaccinations due dates

Emergency contact

Alternate Emergency contact (optional)

Declaration

Dog Service Agreement