Client Information and Agreement |
Please answer all questions that apply to you. If you are already a client and have answered these questions before; please fill in NAME, NUMBER, EMAIL, desired date and time as well as any new information including 'where you will be'. We require up to date agreements every visit. Thank you.
If you need to book immediately, please give us a call after submission:
802 - 439 - 6877
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| 1. |
Check here if you have read The Welcome Letter and General Info and Policies:
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| 2. |
Owner's Name: *
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| 3. |
Email: *
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| 4. |
Home Address:
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| 5. |
Home Phone: *
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| 6. |
Cell Phone:
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| 7. |
Work Phone:
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| 8. |
Name of Veterinarian:
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| 9. |
Phone Number Veterinarian:
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| 10. |
Address of Veterinarian:
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| 11. |
In the box below, please type in the NAME, AGE, (including birth date if you have it) THE SEX, BREED and approximate WEIGHT of each pet:
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| 12. |
Do any of your pets have a problem with fleas? If yes, please explain:
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| 13. |
Do any of your pets have allergies? If yes, please explain:
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| 14. |
Do any of your pets have any sensitive areas on his/her body? If yes, please explain:
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| 15. |
Where are your pets’ favorite petting spots?
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| 16. |
Do any of your dogs act afraid of any specific items or noises? If yes, please explain:
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| 17. |
Are there any kinds of dogs your dog automatically fears or dislikes? If yes, please explain:
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| 18. |
Has your pet ever growled at someone? If yes, what were the circumstances?
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| 19. |
Has your pet ever bitten someone? If yes, what were the circumstances?
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| 20. |
Does your pet have any problems in any of the following areas: BARKING, DIGGING, JUMPING, OTHER? If yes, please explain:
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| 21. |
What commands does your pet know?
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| 22. |
Feeding instructions – Include quantity and times per day:
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| 23. |
Medications and instructions:
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| 24. |
Any other SPECIAL INSTRUCTIONS:
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| 25. |
Desired Drop Off Date:
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| 26. |
Desired Drop Off Time:
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| 27. |
Pick Up Date:
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| 28. |
Pick Up Time:
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| 29. |
Where will you be when we have your pet(s)? Please be specific including the phone number:
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| 30. |
Please give us at least one emergency contact. Name, phone number and relationship:
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| 31. |
You can upload your proof of vaccinations here, or bring it with you to the kennel:
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| 32. |
OWNER AGREEMENT: I (please type your name)
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| 33. |
hereby certify that my pet(s) (please type the name of your pet(s)
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| 34. |
is/are in good health and have not been ill with any communicable condition in the last 30 days. I further certify that my pet(s) have not harmed or shown aggressive or threatening behavior towards any person or other dog. I have read and understand the following:
1. I understand that I am solely responsible for any harm caused by my pet(s) while my pets(s) is/are attending the Country Canine Boarding Kennel.
2. I further understand and agree that in admitting my pet(s) to the Country Canine Boarding Kennel, the Country Canine Boarding staff have relied on my representation that my pet(s) is/are in good health and have not harmed or shown aggressive or threatening behavior towards any person or any other dog.
3. I further understand and agree that the Country Canine Boarding Kennel, and their staff and volunteers, will not be liable for any problems which develop, provided reasonable care and precautions are followed, and I hereby release them of any liability of any kind whatsoever arising from my pet(s) attendance and participation at the Country Canine Boarding Kennel.
4. I further understand and agree that any problems which develop with my pet(s) will be treated as deemed best by staff and volunteers of the Country Canine Boarding Kennel at their sole discretion, and that I assume full financial responsibility for any and all expenses involved.
I certify that I have read and understand the policies of the Country Canine Boarding Kennel as set forth on the preceding pages and that I have read and understand the conditions, and the statements of this agreement.
Please sign and date in the box below if you accept these statements:
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