Enrollment Form
Owner Information
Todays Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Email
*
example@example.com
How did you hear about us?
*
Do you have more than one pet?
*
Yes
No
Pet's Information
Pet's name
*
Date of Birth
*
-
Month
-
Day
Year
Gender
*
Male
Female
Is your dog spayed/neutered?
*
Yes
No
Breed
*
Color
*
How did you get your dog?
*
Ex: adoption, rescue, family, etc
If adopted, do you have any past history about your dog?
Please ensure you give all details regarding your pet's history. Details should include if there has been any physical trauma, health issues, previous home life, previous daycare/boarding visits, etc.
2nd Pet's name
*
Date of Birth
*
-
Month
-
Day
Year
Gender
*
Male
Female
Is your dog spayed/neutered?
*
Yes
No
Breed
*
Color
*
How did you get your dog?
*
Ex: adoption, rescue, family, etc
If adopted, do you have any past history about your dog?
Please ensure you give all details regarding your pet's history. Details should include if there has been any physical trauma, health issues, previous home life, previous daycare/boarding visits, etc.
Behavior & Temperament Questionnaire
Please be honest with the information you provide. This information will be used to better understand the needs of your dog.For example, if your dog has previously bitten someone, it does not automatically mean that we will not board your dog.It means we need to understand the circumstances surrounding the event, so we can insure we provide a positive experience for your dog.
Do you take your dog to the dog park or any other off leash area?
*
Yes
No
How does your dog behave in these environments?
*
Do you consider your dog good with other dogs?
*
Yes
No
With siblings only
Has your dog been injured or attacked by another dog?
*
Yes
No
If yes, please explain
*
Does your dog have any behavioral issues that we need to be aware of?
*
House Training
Jumping
Barking
Digging
Other
None
If other, please explain
*
Please list any special instructions for your dog
Feeding and Medication Information
Is your dog on a prescription diet?
*
Yes
No
What is the purpose of the prescription diet?
*
Name of Food
*
What is your pet's feeding schedule and instructions?
*
Please list any special instructions we should know about
*
Do they have any special medical conditions?
*
Yes
No
If yes, please explain
*
Does your pet have allergies?
*
Yes
No
If yes, please explain
*
Does your pet currently take any medication?
*
Yes
No
If yes, please provide medication name, medication schedule, purpose of medication, and dosage
*
Ex: Apoquel: 1 pill AM and PM - given for allergies
Veterinarian Information
What veterinarian hospital do you visit?
*
Please include the hospital name and veterinarian name
Phone Number
*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Boarding Policies & Release
For myself, my heirs, and any assigns, I hereby release Broad more Kennels, Inc., it agents, officers, subcontractors, employees, animal owners, customers and potential customers of Broad moreKennels, Inc., from any and all liabilities for injuries to myself, my dog, or any other property of mine which arise in any way out of services and/or products provided by or as a consequence of my association with Broadmore Kennels, Inc. I acknowledge and understand that there are certain risks involved in dog ownership, training and care, including but not limited to dog fights, dog bites,to humans or other dogs and the transmission of diseases. With my submission of this form I acknowledge and accept exclusive and sole responsibility for these and all other risks and release. PERSONAL ITEMS: We welcome personal items, which provide your loved one the scents of home. We ask that all items are labeled and please do not bring any items that have sentimental value. While we doeverything in our power to keep these articles safe, clean, and with your pet for their intended use, WE WILL NOT BE HELD RESPONSIBLE FOR ANY ITEM(S) WHICH BECOME LOST OR DESTROYED. RESERVATION CANCELLATION POLICY: We are more than happy to accommodate your reservation request. Please remember that we are holding your reservation request pending your pet's arrival. Many times customers forget that our facilities are limited and that when we become full we have to turn business away. Due to an unmanageable increase in "No Shows" and late cancellations, we have been forced to implement the following policy: Memorial Day thru Labor Day, and Major Holidays are considered PEAK Season Months. During these times, a NON-REFUNDABLE deposit will be required in the amount of $50.00 or 50% of the amount of stay, whichever is less in value. However, the deposit will be applied to your stay, or forfeited if for any reason you cancel or do not show for your reservation. At management discretion a non-refundable deposit may be requested non-dependent upon seasonal requirements.Also, my submission of this form, I hereby authorize Broad more Kennels, Inc., to obtain medical and/or treatments for my dog(s) in the event of illness and/or injury from the veterinarian listed above or the closest Veterinarian Clinic/Hospital and by this document do hereby direct said Veterinarian to provide those records. I understand that full payment is expected upon pickup.
Signature
*
Submit
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