New Client Intake Form

Owner Information
Owner Name*

First NameLast Name
Secondary Owner Name

First NameLast Name
Email*
example@example.com
Secondary Email
example@example.com
Phone Number*
Secondary Phone Number
Emergency Contact*
Instagram Handles (if you'd like to be tagged in photos of your dog)
How did you hear about The Dog Exhauster?*

GoogleYelpRoverInstagramFlier at a local businessPersonal RecommendationMet Audrey out in the wildOther
Dog Health Information
Please send current vaccination records to mtndogadventures@gmail.com, or please request your vet to email them to me directly.
Dog's Name*
Age*
Breed*
Weight*
Veterinarian Name & Contact Information*
Is dog spayed/neutered?*

YesNo
Has your dog been seen by the vet within the last year?*

YesNo
Please indicate which of the following up-to-date vaccinations your dog has.*

RabiesBordatella (Kennel Cough)DistemperLeptosporosis
Please indicate which of the following up-to-date treatments your dog has.*

HeartwormFlea/TickNone of the above
Does your dog have any dietary restrictions when it comes to treats?
Does your dog have any health or mobility issues?
Dog Behavior

The Dog Exhauster specializes in working with a wide range of energy levels and behavioral needs. Please answer all questions honestly to ensure the best quality of care for your pup.
Describe your dog's energy level and daily exercise needs.
How does your dog get along with other dogs?
How is your dog's recall? How is your dog off leash? Does your dog stay within eyesight, within earshot? How strong is your dog's prey drive? Does your dog listen to you when fixated on prey?
How are your dog’s leash manners?
Does your dog have any fears I should be aware of? (Storms, loud noises, vacuum, cars, etc)
Does your dog have any other behavioral quirks I should be aware of? Is there anything else you want me to know?
If you're boarding your dog overnight, please answer the following questions:
What are the dates of your reservation?
What time would you like to drop your dog off?
What time would you like to pick your dog up?
Feeding and medication routine:
Is your dog potty-trained? Does your dog occasionally mark in new places?
When left unattended, does your dog free-roam, or is your dog crate trained? Does your dog bark or whine when left unattended? Does your dog suffer from any other forms of separation anxiety?
Preparing my home: Does your dog have any destructive tendencies? How likely is your dog to steal food left on the counter top?
Waiver and Release of Liability
This Agreement is entered into by and between Audrey Cravotta (hereby "The Dog Exhauster") and dog owner (hereby “Owner”): *

First NameLast Name
1. By enrolling the above named and described dog(s), I represent that I am the legal owner of the named dog(s) and I assume all risks, dangers and responsibility for injuries to the named dog(s). Owner understands and agrees that Owner is solely responsible for any harm to Owner’s dog(s) while Owner’s dog(s) is/are attending The Dog Exhauster.
2. FOOD/MEDS: When boarding overnight, Owner agrees that it is the Owner’s responsibility to leave adequate supply of food, treats, and medications for Owner’s dog(s) during the entire time Owner’s dog is cared for by The Dog Exhauster. Should the food/medication supply need replacement, Owner authorizes The Dog Exhauster to purchase replacement and Owner will reimburse The Dog Exhauster for the actual food and medication costs plus up to $35.00 time/distance trip fee (per occurrence).
3. DOG’S HEALTH: Owner further understands and agrees that Owner’s dog(s) are healthy and will have current vaccinations for rabies, distemper and Bordetella at all times while attending The Dog Exhauster. Owner is not enrolling any dog that has any condition that could potentially jeopardize the health of other dogs or people and has not had any potentially communicable condition within 30 days prior to enrollment. Owner further understands that even if Owner(s) dog is vaccinated for Bordetella (Kennel Cough) there is a chance that the Owner’s dog can still contract Kennel Cough. Owner agrees that Owner will not hold The Dog Exhauster responsible if Owner’s dog(s) contracts Kennel Cough or other dog-dog transmitted ailments.
4. FLEA/TICK POLICY: All dogs must be flea/tick free. Should a dog be observed to have fleas or ticks, dog will be taken in for a veterinary exam, flea/tick medication will be applied, and Owner will be charged at a rate of up to $150.00 - $225 depending on severity and size of dog.
5. RELEASE OF LIABILITY: Owner understands and agrees that during normal dog play, Owner’s dog(s) may sustain injuries. Dog play is monitored by The Dog Exhauster staff to best avoid injury, but scratches, punctures, torn ligaments, and other injuries may occur despite the best supervision. Owner further understands and agrees that neither daycare/boarding nor any of its employees, staff, or volunteers will be liable for any illness, injury, death, and/or escape of Owner’s dog(s) provided that reasonable care and precautions are followed, and Owner hereby releases The Dog Exhauster staff or volunteers of any liability of any kind whatsoever arising from or as a result of Owner’s dog(s) attending The Dog Exhauster.
6. OFF-LEASH WAIVER: Owner understands that Owner’s dog(s) will not have access to a fenced outside area. When let outside to use the restroom or play, owner’s dog(s) will either be restricted to always being on a leash, or will be allowed to roam off-leash per Owner’s express permission. Owner agrees to assume full liability if Owner’s dog(s) escape(s).
Owner gives The Dog Exhauster permission to allow dog(s) to be off leash:*

During off leash pack adventuresNever
7. PERSONAL PROPERTY LIABILITY: Owner understands that Owner is solely responsible for any harm, including to any other pet(s), to the employees or invitees of The Dog Exhauster, or to the equipment, facilities, or other property of The Dog Exhauster, caused by Owners dog(s). Owner also agrees that The Dog Exhauster shall not be responsible or liable for any lost or damaged personal property belonging either to Owner or Owner’s pet.
8. VETERINARIAN LIABILITY AND CARE: Owner agrees to The Dog Exhauster to obtain medical treatment for Owner’s dog(s) if he/she appears ill, injured, or exhibits any other behavior that would reasonably suggest that dog(s) may need medical treatment including anesthesia. Owner agrees to be fully responsible for the cost of any such medical treatment and for the cost of any transportation for the purposes of such treatment.
Owner gives permission to The Dog Exhauster to use Owner’s vet (within 10 miles) or Veterinary Emergency Group for required treatment.*

YesNo
Maximum dollar amount to be spent on veterinary care is (write "0" if above answer is "no"):*
10. ELDERLY / WEAKENED IMMUNE SYSTEM: Boarding extremely old, chronically ill or otherwise debilitated pets requires extra care, which our caring and trained staff is happy to provide. However, special-needs pets, puppies and senior pets naturally have a higher risk of injury, stress-related illness, or exacerbation of any pre-existing condition. As such, by boarding your special-needs pet, puppy or senior pet with The Dog Exhauster you are waiving any claim for injury or illness experienced by your pet while in our care and that is not directly caused by the negligence or lack of care on the part of our staff.
11. CANCELLATION: Owner understands that reservations must be cancelled by 8 p.m. the night before or owner will be charged for the first day of the reservation.
12. PAYMENTS: Owner understands payments are due and payable at the end of each visit. Payment may be made in American currency, Venmo, CashApp, Paypal, Apple Pay, or Rover.
13. LATE PICK-UP: Owner understands and agrees that if Owner’s dog(s) is/are not picked up by the end previously agreed time, then Owner hereby expressly authorizes The Dog Exhauster to take whatever action is deemed necessary for the continuing care of Owner’s dog(s) and Owner agrees and promises to pay to The Dog Exhauster all costs of continuing such care upon demand by The Dog Exhauster.
14. ABANDONMENT: Owner understands that if Owner does not pick up Owner’s dog(s) as scheduled, and fails to communicate and reschedule a new pick-up time within 72 hours of originally agreed-upon pick-up time, The Dog Exhauster shall be authorized to proceed according to the local municipal code governing abandonment of animals.
15. RIGHT OF REFUSAL: The Dog Exhauster reserves the right to refuse admittance to any dog or dismiss any dog that does not meet or maintain the health, temperament or other daycare/boarding standards. The determination shall be made at the sole discretion of The Dog Exhauster.
16. FULL FORCE AND EFFECT: Owner further understands and expressly agrees that each and every of the foregoing provisions contained in paragraphs 1-15 shall be in force and effect and shall apply to each and every occasion on which Owner’s dog(s) stays with The Dog Exhauster for daycare, extended boarding, or other services, as the case may be. This Agreement shall remain in full force and effect as between the parties until and unless otherwise cancelled or superseded by a writing signed by the parties.
Owner hereby certifies that Owner has read and understands this Waiver and Release of Liability and the regulations set forth above. By signing this agreement, Owner agrees to be bound by its terms and conditions.
Signature*

Clear
Today's Date*

MonthDayYear
Date
Please press “Save” before you press “Submit”.

(On mobile, there is a floppy disc save symbol in the top right corner. On a computer, there should be a save button just below this text.)
Should be Empty:

Owner Information

Dog Health Information

Dog Behavior

If you're boarding your dog overnight, please answer the following questions:

Waiver and Release of Liability

Please press “Save” before you press “Submit”.