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Home Number
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Work Number
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Cell Number
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Email
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Second Responsible Party Name
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Second Responsible Party Home Number
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Second Responsible Party Work Phone Number
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Second Responsible Party Cell Phone Number
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Second Responsible Party Email
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Authorized Emergency Contact
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Emergency Contact Home Phone Number
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Emergency Contact Work Phone Number
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Emergency Contact Cell Phone Number
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Emergency Contact Email
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Other people authorized to pick up pet.
Account Password - Please designate a password that will only be known by Bed Bath & Biscuits and those persons you deem authorized topick up your dog(s). Please be advised that your dog(s) will not be released by Bed Bath & Biscuits or any of its representatives to any unknown or authorized persons without knowledge of this password (MUST BE BETWEEN 6-12CHARACTERS IN LENGTH)
How did you hear about us?
Date of Pet Arrival
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Year
Date
Date Pet Leaving
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Date
Pet Name
Breed / Color
Sex
Male
Female
Spay / Neutered?
Yes
No
Weight
Age
Birthday
Microchip
Vet Clinic
Doctor
Vet Address
Vet Phone Number
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Medical Conditions or Allergies
Medications & Schedule
Food & Dietary Instructions
How does dog get along with other animals in house?
Has dog been to a dog park?
Yes
No
Has dog been to Day Care?
Yes
No
Has dog ever been boarded?
Yes
No
Was boarding a positive experience?
Yes
No
Does dog have any sensitve spots?
Does dog have favorite petting spots?
Has dog ever bitten or been bitten? Provide details.
Does your dog have a problem in any of the following areas: chewing/mouthiness; house training; barking; digging; jumping; eating foreign objects; escaping, lightning, thunderstorms, etc… Provide details.
What commands does your dog know?
What toys and games does he like to play?
Has dog had formal obedience training?
If yes, when & where was obedience training?
Initials - I certify my dog(s) meets all of the above requirements.
Initials - I certify I am the legal owner of the dog(s) on this application.
Initials - I certify that, to my knowledge, my dog(s) has not been exposed to Kennel Cough, Distemper, Rabies or Parvovirus within the past 30 days.
Initials - I certify my dog is free from intestinal parasites.
Initials - I certify my dog(s) has been vaccinated as required by Bed Bath & Biscuits.
Pet Parent Name
Pet Parent Signature
Dogs Name - For Pet Parent Signature Section
Date
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Initials - Client & Release of Liability Agreement: I hereby hold harmless and indemnify Bed Bath & Biscuits , its agents, officers, sub-contractors, employees, pet owners, customers, and potential customers (Indemnified Parties) from any and all liabilities, financial or otherwise, for injuries to myself, my pet(s), or any other property of mine which may arise from services that are rendered by Bed Bath & Biscuits or as a consequence of my association with Bed Bath & Biscuits except to the extent caused by gross negligence, bad faith, or intentional misconduct of the Indemnified Parties.
Initials - Client & Release of Liability Agreement: In consideration of the services rendered by Bed Bath & Biscuits, I agree to assume any all liability financial or otherwise, for the behavior and health of my pet arising in connection with such services. I waive any and all claims, actions, or demands of any nature, either foreseen or unforeseen, that I may have against Bed Bath & Biscuits relating to the care, control, health, and safety of my pet arising in connection with the services that are rendered by Bed Bath & Biscuits except to the extent caused by gross negligence, bad faith, or intentional misconduct of the Indemnified Parties.
Initials - Client & Release of Liability Agreement: I hereby authorize Bed Bath & Biscuits, its agents, officers, sub-contractors, and employees to do whatever they deem necessary for the safety, health, and well-being of my pet while under the care of Bed Bath & Biscuits.
Initials 4 - Client & Release of Liability Agreement: By signing below, I acknowledge that I have read this agreement and release of liability in its entirety and agree to the terms. This agreement shall be binding for every time services are rendered by Bed Bath & Biscuits on my behalf.
Signature - CLIENT AND RELEASE OF LIABILITY AGREEMENT
Date - CLIENT AND RELEASE OF LIABILITY AGREEMENT
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Dog Name - CLIENT AND RELEASE OF LIABILITY AGREEMENT
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