Boarding & Daycare Agreement
Owner Information
Full Name
*
First Name
Last Name
Address Line 1
*
Address Line 2
City
*
State
*
Zip
*
Primary Phone
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Emergency Contact
Please list a secondary contact other than yourself
Full Name
*
First Name
Last Name
Primary Phone
*
-
Area Code
Phone Number
Pet 1
Name
*
Breed
*
Weight
*
Color
*
Birth Date
*
-
Month
-
Day
Year
Date
Your pet is:
*
Spayed (females)
Neutered (males)
Unaltered
Has your pet ever attended Pet Daycare?
*
Yes
No
Has your pet ever bitten a person or another animal?
*
Yes
No
If yes, please explain
Has your pet ever been aggressive with people or other animals?
*
Yes
No
If yes, please explain
Please describe any physical or medical issues (include seizures, asthmatic symptoms, Pancreatitis separation anxiety, food allergies, etc):
Pet 2
Name
Breed
Weight
Color
Birth Date
-
Month
-
Day
Year
Date
Your pet is:
Spayed (females)
Neutered (males)
Unaltered
Has your pet ever attended Pet Daycare?
Yes
No
Has your pet ever bitten a person or another animal?
Yes
No
If yes, please explain
Has your pet ever been aggressive with people or other animals?
Yes
No
If yes, please explain
Please describe any physical or medical issues (include seizures, asthmatic symptoms, Pancreatitis separation anxiety, food allergies, etc):
Boarding & Daycare Agreement
Owner certifies the accuracy of all the information conveyed about the Owner's pet(s) to the Facility.
Owner authorizes the Facility to obtain medical and vaccination records for the pet(s) listed above from their veterinarian listed above.
Owner agrees to not bring pet(s) to Facility if pet(s) exhibit any signs of illness that may be harmful to the other pets in attendance such as vomiting, diarrhea, coughing, extreme lethargy, etc. without first obtaining approval from the Facility.
Facility shall exercise reasonable care for Owner's pet(s) while they is/are in the Facility's custody. The Owner recognizes the potential risks (such as illness and/or injury) involved with pet daycare, boarding and grooming. The Facility does not allow any aggressive dogs for boarding, daycare or grooming
Facility may change the level or type of daycare/boarding or possibly remove pet(s) from group play, if Facility believes it necessary to ensure the safety of the Owner's pet(s}, other pets or its employees.
Owner represents to the Facility that Owner is over 18 years of age: that all information provided about the Owner is accurate: and that all credit card information is accurate.
Owner agrees to the policies and procedures posted in the Facility's lobby and on its website on check-in date. The Facility reserves the right to adjust said Policies and Procedures without prior notice.
Owner gives the Facility consent to act in the Owner's behalf to obtain veterinary services if Owner's pets(s) become(s) ill or require(s) the attention of a veterinarian. The Owner agrees that the Facility, in its sole discretion may engage veterinarian services, administer medicine to give other requisite attention to the pet(s); that all expenses incurred shall be paid by the Owner; and agrees to indemnify and hold the Facility and its employees harmless from said expenses
Owner agrees to pay for all charges incurred for: special services requested, veterinary costs as stated above and failure to comply with the Facility's Cancellation Policy.
Facility shall have the right to refuse to release Owner's pet(s) until Owner has paid all charges due to the Facility. The Facility is hereby granted a lien on the Owner's pet(s) for any and all unpaid charges resulting from boarding, day care and all liability and expenses incurred as a result of said injuries.
Owner assumes any and all liability and expenses for injuries inflict upon any human or other pet(s) by Owner's pet(s) while in the Facility. Owner agrees to indemnify and hold the Facility and its employees harmless from any and all liability and expenses incurred as a result of said injuries.
Facility has the right to take photographs and/or videos of Owner's pet(s) while in the Facility's care. The Facility may post or reproduce any and all photographs/videos taken (as well as pet(s) name) on or in without limitation, the Facilities website, social media sites or promotional materials without becoming liable to the Owner (or the Owner's pet(s)) for any royalty payment. Owner hereby releases covenants not to sue and forever discharges the Facility of and from any and all claims demand, rights, and causes of action of written approval from Facility's Corporate Offices.
Owner agrees that the Facility's liability shall not exceed the current chattel value of a dog or cat of the same species delivered to the Facility
This Agreement contains the entire agreement between the parties and shall be binding on the heirs, administrators, personal representatives and assigns of the Owner and the Facility.
Owner releases indemnifies and holds the Facility harmless from any and all manner of damages, claims, losses, liabilities, costs or expenses, causes of action or suits, whatsoever in law or equity (including, without limitation, attorney's fees and related costs) arising out of or related to the services provided by the Facility including, without limitation:
Any inaccuracy in any statement made by Owner or information provided by Owner to the Facility:
Your pet(s) including but not limited to destruction of property, pet bites and transmission of disease;
Any action by Owner which is in breach of the term and conditions of this Agreement.
Any controversy of claim relating to this Agreement shall be settled by arbitration in accordance with the rules of the American Arbitration Association. Judgment upon the award rendered by an arbitrator may be entered in any court having jurisdiction thereof.
This is an Agreement between Cliftwood Animal Hospital (referred to as "Facility") and the pet(s) Owner whose signature appears below (referred to as "Owner'')
Your Name
*
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: