HOUSE OF DOG RETREAT & SPA LLC (Application, Medical Release, Agreement and Vaccines)

HOUSE OF DOG RETREAT & SPA LLC
How did you hear about House of Dog Retreat & Spa, LLC?
Name

First NameLast Name
Address*

Address

Street Address Line 2

CityState

Zip
Home Phone*
Cell ( )*
Cell
Email*
example@example.com
If we can't get in touch with you who can we call? Contact)
Emergency Contact
Address

Address

Street Address Line 2

CityState

Zip
Home Phone
Cell ( )
Email
example@example.com
Name of Vet
Address*

Address

Street Address Line 2

CityState

Zip
Pet's Name
Spayed/Neutered (y/n)
Age
Birthday
Breed
Color
Weight
Micro Chip Y / N #
Sex
Feeding Schedule
Brand and Type of Food
Is your dog allowed to have treats? Y / N If yes, what type
How long have you had him/her?
Are there any other animals in the household? (Species/ Breed / Age)
Please describe your dog's overall temperament
How does your dog react to other dogs? (Generally)
Has your dog every participated in play at a dog park? ?Y/N If yes, how did he/she react with the other
How does your dog react to strangers?
Does your dog have any kinds of people he/she automatically fears or dislikes? Y / N If yes, describe:
If yes, describe
Does your dog have any kinds of dog that he/she automatically fears or dislikes? Y / N
Has your dog ever bitten someone? Y / N If yes, describe
Has your dog ever been in a fight or bitten another dog? Y / N
If yes, describe
Has your dog ever escaped or attempted to escape by digging/jumping or climbing fences? Y / N
Does your dog jump on people? Y/N If yes, describe
Distance?
other exercise does your dog receive?
Do you walk your dog? Y / N How often?
What known behavioral problems does your dog have?
Does your dog have a circumstance or situation that he/she is frightened of? Y/ N
Describe how you would calm the dog during this situation
Is your dog housebroken or crate trained?
Does your dog play with toys? Y
Does your dog play with toys? Y / N What kind
Is your dog toy possessive? Y / N Describe
Has your dog shared toys/food/water with other dogs before? Y / N
Where there any problems
Has your dog ever played on playground or agility equipment before? Y/N
Do you feel that play equipment would be inappropriate for your dog? Y / N
Describe
Has your dog ever received any formal training? Y N N Where and When?
Does your dog know any commands? Y / N Describe
What do you do with him/her when you leave the home?
How does he/she react when you get home?
Does your dog have any health concerns that you are aware of? Y / N
Does your dog have any medical restrictions on his/her activities? Y / N
Is your dog currently on any medication? Y / N
Does your dog have any allergies? Y / N
Does your dog like to receive brushings? Y / N How often is he/she brushed?
How often is he/she brushed?
How does your dog react to getting his/her nails clipped?
Does your dog have any areas on his/her body that he/she does not like to be touched? Y/N
Does your dog have a special place that he/she likes to be petted or rubbed? Y / N
Describe
Does your dog receive flea and tick preventative? Y / N
Brand
Type
Frequency
Is there anything else that you believe we should know about your dog?*
When would you like to start? Are you applying for boarding? If so please list the dates*

HOUSE OF DOG RETREAT & SPA LLC MEDICAL RELEASE FORM
This is a required form for all House of Dog Retreat & Spa, LLC clients receiving services. The safety and well-being of your pet(s) is of the highest importance. Insuring that your pet remains safe and well cared for while visiting House of Dog Retreat & Spa LLC is our primary responsibility. In the event a medical emergency arises while your pet is visiting at House of Dog Retreat & Spa LLC or participating in a service that House of Dog Retreat & Spa LLC provides, it is imperative that we are immediately able to get your dog(s) medical treatment at the closest available medical facility.

1.    House of Dog Retreat & Spa LLC will call ahead to the veterinary offices in closest proximity geographically to House of Dog Retreat & Spa LLC to insure they can respond to the emergency immediately.

2.    Your dog(s) will be rushed to the closest available facility for treatment.

3.    You will be immediately notified of the situation and plan of action. However, House of Dog Retreat & Spa LLC may notify you after medical treatment has been determined and your dog(s) have received medical attention. This is done in an effort to avoid delays and for the benefit of your dog(s). In the event of an emergency, House of Dog Retreat & Spa LLC’s goal is to get your dog(s) medical attention as quickly as possible, and any distractions may interfere with that process.

Owner Acknowledgement:
IOwner's Name* understand that in the event of a medical emergency, the House of Dog Retreat & Spa, LLC, at its sole discretion, may deem it necessary to seek immediate attention of a licensed veterinarian for my dog(s) Dog(s) Name*I authorize House of Dog Retreat & Spa, LLC to seek medical attention at the closest available veterinary facility. I further agree that I am financially responsible for any medical treatment costs and/or medical emergency expenses incurred at said veterinary facility.
Name*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date

HOUSE OF DOG RETREAT & SPA, LLC PET CARE AGREEMENT
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Dog's Name:*
Age:*
Breed:*
1. I, the Owner of the above named Dog, understand that House of Dog Retreat & Spa, LLC has relied upon my representation that my dog is in good health and has not injured or shown aggression or threatening behavior to any person or dog in admitting my dog for services at their facility.

2. I understand that if my dog(s) display aggressive, harmful or nuisance behaviors, for the safety of other dogs and the employees of House of Dog Retreat & Spa, LLC, that my dog may be corrected and/or confined to a kennel until he/she can be picked up.

3. I understand that House of Dog Retreat & Spa, LLC reserves the right to permanently remove any dog at any time and refuse admittance to any dog(s) which do not meet the health and temperament requirements which include, but are not limited to inoculations for distemper, bordetella, rabies and flea and heartworm prevention.

4. I understand that there are risks and benefits associated with group socialization of dogs. I agree that the benefits outweigh the risks and that I accept the risk. I desire a socialized environment for my dog. I understand that while the socialization and play is closely and carefully monitored by House of Dog Retreat & Spa, LLC staff to prevent injury, it is still possible that during the course of normal play, my dog may receive (but not limited to) nicks, bites, illnesses, scratches, and other injuries from roughhousing and playing with other dogs.

5. I acknowledge the risks associated with daycare, boarding, and/ or any other related services provided by House of Dog Retreat & Spa, LLC and hereby confirms acceptance of the same and further understands that House of Dog Retreat & Spa, LLC their owners, staff, partners and volunteers, will not be liable, financially or otherwise, for any injuries or illnesses that my dog may sustain or contract, injuries or illnesses that I may sustain or contract, and any property of mine that may be lost or damaged while my dog is participating in services provided by House of Dog Retreat & Spa, LLC.

6. I acknowledge and agree that I shall be fully responsible, financially and otherwise, for any harm, damage, claim, liability, injury, sickness, or loss which I or my dog(s) may sustain or which may be caused in any way by my dog(s) while my dog(s) is participating in open play, daycare, boarding, grooming, bathing, or any other service or activity at the House of Dog Retreat & Spa, LLC, including but not limited to paying any medical/veterinary expense incurred as a result of sickness or injury occurring on the grounds or surrounding area of the House of Dog Retreat & Spa, LLC or caused by any confrontation among dogs while in the supervision of the House of Dog Retreat & Spa, LLC. I hereby agree to indemnify, release, and hold harmless the House of Dog Retreat & Spa, LLC, its owners, directors, officers, members, employees and agents against the same.

7.      I hereby release and agree to hold harmless House of Dog Retreat & Spa LLC, its owners, directors, officers, members, employees and agents from any and all liability, claims, suits, actions, loss, injury or damage of any nature or kind, or for any liability, claims, suits, actions, loss, injury or damage which I or my dog(s) may sustain or which may be caused in any way by my dog(s).

8.      I, specifically without limitation, agree to fully indemnify House of Dog Retreat & Spa LLC for any and all such liability, claims, suits, actions, losses, injury or damage.

9.      I, specifically agree to indemnify and hold harmless House of Dog Retreat & Spa LLC. as to any loss, cost, claim, injury, damage or liability, sustained or incurred (regardless of cause) of an employee, representative, or agent of House of Dog Retreat & Spa LLC.

10. I further understand and agree that any problems with my dog, behavioral, medical or otherwise will be treated as deemed best by staff of House of Dog Retreat & Spa, LLC in their sole discretion, and in what they view as the best interest of the animal. I understand that I assume full financial responsibility and all liability for any and all expenses involved in regard to the behavior and health of my dog.

11. I understand that if my dog is not picked up on time or by a date specified in a separate agreement, I hereby authorized House of Dog Retreat & Spa, LLC to take whatever action is deemed necessary for the continuing care of my dog. House of Dog Retreat & Spa, LLC will make every attempt to contact me. I will pay House of Dog Retreat & Spa, LLC the cost of any such continuing care upon demand by House of Dog Retreat & Spa, LLC. I understand that if I do not return for my dog after 7 days and having no contact with me, House of Dog Retreat & Spa, LLC will consider the dog(s) to be abandoned and will re-home the dog(s). I also acknowledge that I will be fully responsible for all attorney’s fees and associated costs if I abandon my dog.

12. I give consent for my dog to be photographed while in the facilities at House of Dog Retreat & Spa, LLC. I agree to give House of Dog Retreat & Spa, LLC permission to use my dog’s image on promotional materials, which may include its website and Facebook fan pages.

13. I agree to pay all charges incurred by the services I or my dog(s) receives while in the care of House of Dog Retreat & Spa, LLC.

I certify that I have made full disclosure and have read, understand and accept the terms, conditions and statements in this agreement. Furthermore, I acknowledge that this agreement shall be effective and binding upon parties.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

Clear

Vaccinations

Please upload a copy of your dog's Rabie's Certificate and current shot records. (Must include Bordatella and DAPP)
Rabies
Vet License Number*
Vaccine Lot #*
Rabies Next Vaccination Due*

MonthDayYear
Date
Bordatella Next Vaccination Due*

MonthDayYear
Date
Distemper/DAPP Next Vaccination Due*

MonthDayYear
Date
Please upload a copy of your Rabies Certificate Only ( Image must be showing Vet ID # and Vacc Lot #.*

Cancelof
Please upload copies of your dog's current shot records. (Bordatella & Distemper issue date or next vaccination due must be visible in document)*

Cancelof

I blanks* , authorize House of Dog Retreat & Spa LLC to charge my card for the amount above for a temperment test. I understand my information will be saved to file future transactions on my account.
Signature*

Clear
Should be Empty:

HOUSE OF DOG RETREAT & SPA LLC

HOUSE OF DOG RETREAT & SPA LLC MEDICAL RELEASE FORM

HOUSE OF DOG RETREAT & SPA, LLC PET CARE AGREEMENT

Vaccinations

Rabies