CityPaws New Customer Form

Owners Last Name*

First Name*

Additional Owner(s) or authorized person(s) for pick-up:

Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Name and Phone Number

Owners Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Emergency Contacts (Must be local):

Name*

Phone*

Preferred Vet Contact

Name*

Phone*

Address*

*Owner will be contacted in case of an emergency and prior to calling preferred vet.*

DOG Name*

Breed*

Color*

Gender*

MaleFemale

Spayed/Neutered*

YesNo

Weight (LBS)*

Age

Please list any known allergies*

Please list any known medical conditions or medical issues*

Is your dog on any medications? If yes, list medications, dosage, and times.

Monthly Flea/Tick Treatment*

Agressive?*

YesNo

If yes, please specify leashed, people, or dog)

Chewer*

YesNo

Excessive Barking*

YesNo

Biter*

YesNo

Crate Trained*

YesNo

Other behavioral issues CityPaws staff should be aware about?*

Pet's Name*

Pet Breed*

Owner's Name*

Owner's Phone Number*

As the owner (or owner's agent) of the above-referenced pet, I have read and agree to the following:

1) Services. The above referenced Owner (the "Owner" or "you" or "your"), desires to purchase pet grooming, medication administration, feeding and other pet-related services (the "services") provided by CityPaws Pet Services, LLC (hereinafter "CityPaws"), a Texas limited liability company (the "Company" or "we" or "us"

2) Current Vaccinations/Veterinarian Information. By signing this agreement, you confirm that your pet(s) has received up-to-date vaccinations, including but not limited to rabies, distemper, and parvovirus. You agree to provide proof of vaccinations and current veterinarian information upon request by the Company.

I acknowledge that the Company will not be held liable for any communicable diseases may acquire.*

Sign your initials above.

3) Pricing. The Company will give you an estimated quote for the grooming services before proceeding. Please be aware that the quote is an initial estimate and may be adjusted. The basic grooming services provided are determined by your pet's weight and include shampooing, coat conditioning, grooming, nail trimming and grinding, anal gland expression, sanitary trimming, ear cleaning, ear hair removal, cologne, and a bandana. It is important to note that the Company cannot be held responsible for any irritation or car infections that may occur after car hair removal. You acknowledge that it is your duty to monitor your pet's ears after the treatment.

I authorize the Company to charge an additional fee for using flea and tick shampoo on without further notification.*

Sign your initials above.

4) Mat Removal. Pets with matted coats require special attention during grooming to prevent potential health issues. Matting, which consists of tangled and knotted hair, can lead to infections, skin irritations, and other problems. Our groomers will evaluate your pet's coat and determine the best approach for removing the mats while minimizing stress. Please note that removing mats can be challenging depending on their location and severity. Additionally, heavy mats can create a moist environment near the skin, which may promote the growth of mold, fungus, or bacteria.

I understand that there will be an extra fee for de matting my pet. The Company will verbal consent for any additional services needed.*

Sign your initials above.

5) Payment. Full payment is required at the time services are provided, and this payment is nonrefundable. If you fail to pick up your pet by the end of the scheduled appointment day, they will be boarded at the kennel rate of $50 per night. For grooming appointments booked four days before a designated holiday, a $20 deposit is necessary. This deposit will be applied to the final balance of services charged when you pick up your pet. However, if you cancel or fail to show up

CityPaws Consent and Release of Liability

for the appointment, the deposit will be forfeited and cannot be used for future services.

I acknowledge that my pet will not be released until fees are paid in full.*

Sign your Initials above.

6) Satisfaction. We value your satisfaction. If you have any concerns about your pet's grooming, please contact us within 24 hours of the appointment. We will make reasonable efforts to re-groom your pet, excluding bathing services, within five business days of the original visit. The re-groom will be conducted by the same groomer who initially worked on your pet.

I understand refunds will not be offered for grooming services previously rendered.*

Sign your initials above.

7) Health and Medical Problems. You give the Company permission to seek immediate medical treatment for your pet if deemed necessary. The Company will make reasonable efforts to contact you before doing so, except in cases where immediate treatment is required. You are responsible for all expenses related to any necessary medical care provided by the Company. If your pet sustains any previously undisclosed injuries during the grooming service, you must report them within 24 hours. You understand that it is your sole responsibility to inform the Company about any pet allergies, illnesses, health conditions, habits, or behaviors that may affect the services or the safety of the Company's personnel. This information is important for the well-being of your pet and the safety of the staff.

I authorize the Company to provide necessary medical treatment for my pet in case of injury or illness. I release and hold harmless the Company and its affiliates from any liability related to my pet's treatment. I understand that I am solely responsible for any medical treatment expenses in the event of illness or injury during the services. *

Sign your initials above.

8) Release of Claims and Indemnification. THERE IS ALWAYS THE POSSIBILITY THAT AN ACCIDENT COULD OCCUR. THE EQUIPMENT USED IN PROVIDING THE SERVICES IS SHARP, EVEN THOUGH WE USE EXTREME CAUTION AND CARE IN ALL SITUATIONS, POSSIBLE INJURIES COULD OCCUR INCLUDING CUTS, NICKS, SCRATCHES, QUICKING OF NAILS, ETC. YOU HEREBY EXPRESSLY WAIVE AND RELEASE ANY AND ALL CLAIMS WHICH YOU MAY HAVE, OR WHICH YOU MAY HEREAFTER HAVE, WHETHER KNOWN OR UNKNOWN, AGAINST THE COMPANY, AND ITS SUBSIDIARIES, OFFICERS, DIRECTORS, MANAGERS, EMPLOYEES, AGENTS, AFFILIATES, SHAREHOLDERS, MEMBERS, SUCCESSORS, AND ASSIGNS (COLLECTIVELY, "RELEASEES"), ON ACCOUNT OF INJURY, ILLNESS, DISABILITY, DEATH, OR PROPERTY DAMAGE ARISING OUT OF OR ATTRIBUTABLE TO YOUR PARTICIPATION IN THE SERVICES OFFERED BY THE COMPANY WHETHER ARISING

OUT OF THE ORDINARY NEGLIGENCE OF THE COMPANY OR ANY RELEASEES OR OTHERWISE. YOU COVENANT NOT TO MAKE OR BRING ANY SUCH CLAIM AGAINST THE COMPANY OR ANY OTHER RELEASEE, AND FOREVER RELEASE AND DISCHARGE THE COMPANY AND ALL OTHER RELEASEES FROM LIABILITY UNDER SUCH CLAIMS. THIS WAIVER AND RELEASE DOES NOT EXTEND TO CLAIMS FOR GROSS NEGLIGENCE, INTENTIONAL OR RECKLESS MISCONDUCT, OR ANY OTHER LIABILITIES THAT GEORGIA LAW DOES NOT PERMIT TO BE RELEASED BY AGREEMENT.

CityPaws Consent and Release of Liability

YOU SHALL DEFEND, INDEMNIFY, AND HOLD HARMLESS THE COMPANY AND ALL OTHER RELEASEES AGAINST ANY AND ALL LOSSES, DAMAGES, LIABILITIES, DEFICIENCIES, CLAIMS, ACTIONS, JUDGMENTS, SETTLEMENTS, INTEREST, AWARDS, PENALTIES, FINES, COSTS, OR EXPENSES OF WHATEVER KIND, INCLUDING ATTORNEY FEES, FEES AND THE COSTS OF ENFORCING ANY RIGHT TO INDEMNIFICATION UNDER THIS RELEASE, AND THE COST OF PURSUING ANY A INSURANCE PROVIDERS, ARISING OUT OF OR RESULTING FROM ANY CLAIM OF THIRD PARTY RELATED TO YOUR PARTICIPATION IN THE SERVICES, INCLUDING ANY CLAIMS ARISING OUT OF YOUR OWN NEGLIGENCE OR THE ORDINARY

I have read the Release of Claims and Indemnification provision and agree.*

Sign your Initials above.

9) Aggressive or Dangerous Pets. Pet owners are required to inform the Company if their pet has a history of biting or aggression towards people, other animals, or specific grooming procedures. In certain situations, it may be necessary to use a muzzle or humane restraints to ensure the safety of both the pet and the groomer. If, for any reason, your pet cannot be bathed or groomed while using a muzzle or restraints, you will be notified, and you will only be charged for the services that were performed. Additionally, the Company reserves the right to refuse future services for pets that are deemed unmanageable or dangerous.

You acknowledge that if your pet intentionally tries to bite the groomer or is without the use of a muzzle, an additional handling fee may be charged.*

Sign your initials above.

You further understand that if your pet bites or causes injury to any person working behalf of the Company, you agree to take full responsibility for any related medical recovery costs, loss of income, and equipment damage incurred as a result of the incident.*

Sign your initials above.

10) Sedatives. If an animal exhibits high anxicty, behavioral issues, or has had negative experiences with grooming in the past, the Company may consider using a mild sedative to help facilitate the grooming process. However, the use of sedatives is subject to approval and prescription by the animal's veterinarian prior to the grooming service. The Company reserves the right to refuse grooming services if an animal cannot be safely and humanely restrained, displays excessive aggression, or poses a risk to themselves or the groomers, even with the use of sedatives. The decision to refuse service in such cases is made to prioritize the safety and well-being of the animal and the groomers.

11) Consent to Use Photos. You grant the Company unrestricted permission to utilize your pet's name and likeness for promotional purposes related to the services they provide. This means that the Company has the right to use your pet's name, photographs, or any other representation of your pet in their advertising, marketing materials, website, social media platforms, or any other form of publicity.

CityPaws Consent and Release of Liability

By signing this Release, you acknowledge that you are waiving all claims related to your participation in the services, including any claims that may currently be unknown or unforeseen. This Release represents the entire agreement between the Company and you regarding this matter, replacing all previous understandings and agreements, whether written or verbal. If any part of this Release is deemed invalid or unenforceable in a specific jurisdiction, it will not affect the validity or enforceability of the remaining terms. This Release is binding on both the Company and you, as well as their respective heirs, successors, and assigns. Any disputes arising from this Release will be governed by the internal laws of the State of Texas, disregarding any conflicting legal provisions.

Signature*

Clear

Print Name*

Date*

Date

OWNER INFORMATION FORM

DOG INFORMATION FORM

MEDICAL INFORMATION

BEHAVIORAL INFORMATION

CityPaws Consent and Release of Liability