New Client Form
We appreciate your business and taking time out of your day to tell us more about your dog so we can provide the best care possible. Thank You!
Pet Information
Dog's Name
*
Gender
*
Male
Female
Is your dog spayed/neutered?
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No
Yes
Breed
*
Color
*
Birthday (Approximate)
*
-
Month
-
Day
Year
Date
How did you hear about us?
If you have two dogs from the same household, do you request they share a room for overnight boarding? Please put N/A if you do not have additional pets.
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I understand that Waggin' Tails Retreat can not be held liable for any injuries caused by dogs from the same household sharing a room. I understand and agree to have my dogs share a room. Please fill in N/A or No if this does not apply to you.
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Initial
Owner Information
Name
*
First Name
Last Name
Secondary Contact (Partner, Spouse, Child)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Vet Records & Information
Please upload your pet vaccination records. You can also have your vet clinic email your dogs records.waggintailsretreat@gmail.com
File Upload
Browse Files
Drag and drop files here
Choose a file
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Vet Clinics Name
*
Vet Clinic Phone Number
*
Please enter a valid phone number.
** I authorize emergency care from the closest vet to be billed directly to me by the vet.**
Signature
*
Emergency Contact
This must be someone other then yourself or your secondary contact. We will ask for an additional contact if you list yourself. (This is a person we can contact in the event of an emergency and you are out of town!)
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Overnight Information
How many times a day does your dog eat?
*
1x a day
2x a day
3x a day
Other
If other please explain
If you feed 1x a day please indicate if it is AM or PM
How much food do you feed per meal?
*
What type of dog food does your dog eat?
*
Does your dog have any dietary restrictions or allergies? If yes, please explain. *
*
Is your dog on any kind of medication? If yes please list the name, how often it is administered and dosage. We will ask that you bring the medication in the bottle with accurate dosage on bottle.
*
Does your dog have any pre-existing health conditions or any type of activity restrictions? If yes, please explain. *
*
Does your dog have a history of ingesting foreigner objects or has previously required surgery due to an obstruction? *
*
Is your dog, dog friendly ? Please explain
*
Legal Waiver and Indemnity Agreement
I understand that I am responsible for any harm caused by my dog while my dog is attending Waggin' Tails Retreat, Inc. I shall indemnify and hold harmless Waggin' Tails Retreat, Inc. and it's owners Kara L. Schroeder and Kenneth A. Schroeder, against any damages of any kind suffered by Waggin' Tails Retreat, Inc. or its owners as a result of failure to inform Waggin' Tails Retreat, Inc. of any pre-existing conditions the dog may have (such as illness or aggression problems. I understand and agree that in admitting my dog is in good health and has not harmed or shown aggressive or threatening behavior towards any person or any dog.
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Initial
I understand Waggin' Tails Retreat, Inc. is a place where animal's co-mingle in groups and recognize that there are inherent risk when dealing with animals. I do hereby waive and release Waggin' Tails Retreat, Inc., Kara L. Schroeder and Kenneth L. Schroeder from any and all liability of any nature. This includes any injury, death, sickness, or damage my pet may suffer during or after daycare or during boarding.
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Initial
I understand that if I request multiple dogs from the same household share a room that Waggin' Tails Retreat is not responsible for any injuries caused by dogs from the same household. I do hereby waive and release Waggin' Tails Retreat, Inc., Kara L. Schroeder and Kenneth L. Schroeder from any and all liability of any nature. This includes any injury, death, sickness, or damage my pet may suffer.
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Initial
I understand that Waggin' Tails Retreat, Inc. is fully insured. I understand and agree that Waggin' Tails Retreat, Inc. and its owners Kara L Schroeder and Kenneth A. Shroeder will not be held liable for problems, damages or injury caused by my dog provided reasonable care and precautions are followed by staff.
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Initial
I understand that when dogs play in groups, nicks and scratches or possible injury may occur. Waggin' Tails Retreat staff may or may not notify me immediately. If injury is not serious, staff may feel it is acceptable to leave the dog until the end of the day and let me know about it when I pick up the dog. If injury is serious, I will be notified immediately.
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Initial
If my dog should become ill or seem to be in need of medical attention, Waggin' Tails Retreat, Inc. reserves the right to take any and all medical attention deemed necessary to secure the well being and health of my pet including any medical attention deemed necessary. My vet or the nearest emergency vet will be contacted in the event of a medical problem. I agree to reimburse Waggin' Tails Retreat, Inc. for any and all expenses incurred.
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Initial
I understand that if my dog is left at Waggin' Tails Retreat, Inc. for a period of four days after scheduled pick-up without contact from the owner. The dog or dogs will be considered abandon and necessary steps will be taken to turn the dog over to the proper authorities.
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Initial
Signature
*
* I have initialed each statement above to acknowledge my understanding and acceptance.*
Submit
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