Pet Nanny HB

Owner Information

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

How Did You Hear About Us?*

Dog Information

Dog's Name*

Breed*

Age*

How Old Was The Dog When You Acquired It?*

Gender*

MaleFemale

How Long Have You Owned The Dog?*

Has Your Dog Been:*

SpayedNeuteredNone of the Above

Where Did You Acquire Your Dog?*

Where Does Your Dog Sleep At Night?

Is Your Dog House Trained?

Veterinary Information

Veterinarian

Vet Clinic

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Is Your Dog Current On All Vaccinations Including Kennel Cough, Parvo, Hepatisis?*

YesNo

Vaccination Dates:*

Please List All Medications Your Dog Is Currently Taking. Please Include Heartworm, Flea and Tick Medications, etc*

Please List Any Medical Problems Your Dog Has Had:*

Behavior Information

Has your dog shown any unfriendly or aggressive behaviour (including fearful reactive) towards other dogs, humans or other animals? If yes please describe the behaviour and any known triggers

Behavior Problems:*

Does Your Dog Know How To Walk On A Leash?*

YesNo

Does your dog have any other special care requirements, health or behaviour issues, or concerns Pet Nanny needs to be aware of? If yes, please specify:

Daycare

Type of Day Care

Full Day ($45)Half Day ($30)

Extra

Early Morning/Late Night ($20)Overnight stay ($25)

AGREEMENT TO HOLD HARMLESS, WAIVER AND ASSUMPTION OF RISK

I, the owner of the dog named in this agreement, understand and agree to the following:

1. I understand that Pet Nanny Hawkes Bay will take all necessary precautions to ensure the utmost safety of my dog while in their care. However, I acknowledge and accept that due to the nature of dogs, particularly when interacting in a group, as well as the tendency of dogs to scavenge, and the location/terrain of some adventures, accidents and injuries can occur and I will not hold Pet Nanny Hawkes Bay responsible (this includes physical injury, illness, damage to harness, lead, toys or other equipment, and the consumption of unknown food/foreign objects etc)

2. Any costs incurred from damage, illness or injury to my dog during play or exercise will be solely my own responsibility

3. I am solely responsible for any costs incurred for any sickness, injuries, or death to any other dog, animal, or person caused by my dog while with Pet Nanny Hawkes Bay

4. All booking fees will be paid in advance to Pet Nanny, account:

02 0261 0165030 007

5. I have disclosed all necessary information to ensure the safety of my dog and others while in the care of Pet Nanny Hawkes Bay

Signature

Name

First NameLast Name

Date

By Clicking The Submit Button You Agree To The Above Terms