New Client Form - Dog

Please fill out one form per pet.

Owner's Information
Owner's Name: *
Owner's Name:
Second Owner's Name:
Second Owner's Name:
Address: *
Address:
Cell Phone: *
Cell Phone:
Home Phone:
Home Phone:
Work Phone:
Work Phone:
Second Owner's Phone:
Second Owner's Phone:
Emergency Contact (someone outside of your household): *
Emergency Contact (someone outside of your household):
Emergency Contact Phone Number: *
Emergency Contact Phone Number:
Dog's Information
Date of Birth:
Date of Birth:
Sex: *
Veterinarian's Information
Phone:
Phone:
Date of Last Visit:
Date of Last Visit:
Vaccination Records - Please bring vaccination records or have them faxed to 920-685-5923
Required: Rabies and distemper. Bordetella is highly recommended for any service.
Has your dog had fleas or ticks in the last year? *
Is your dog on heart worm prevention? *
Feeding Schedule
Time of Day: *
Brand: *
Please note additional diets here
If you plan on bringing your dog for a day of daycare, will you be bringing a lunch or snack? *
Medications
Time of Day:
Date:
Date:
Time:
Time:
All About Your Dog
Does your dog have any problems in the following areas?
Does your dog have any physical problems or disabilities that we should be aware of? *
Does your dog prefer to play with: *
Is your dog afraid of any types of other dogs? *
Has your dog ever broken skin or caused a puncture by biting another dog? *
Has your dog ever growled or snapped while sharing toys or objects with another dog? *
Has your dog ever growled or snapped at a person for taking food, toys, or objects away? *
Has your dog ever broken skin or caused a puncture by biting someone? *
Has your dog played off-leash with other dogs? *
What is your dog's training history? *
Are there any behavioral or training issues that you feel you should inform us of? *
About Your Dog's Home Life: *
Has your dog ever jumped over a fence? *
This is a Contract between See Spot Run on 21 and the pet owner whose signature appears below (hereinafter called “Owner”)
I have read and agree to the terms and conditions listed below.
Today's Date: *
Today's Date:

Terms and Conditions

1. Owner agrees to pay the rate for boarding in effect on the date pet is checked out.

2. Owner further agrees to pay all costs and charges for special services requested, and all veterinary costs for the pet during the time said pet is in the care of See Spot Run on 21 (SSR). Grooming prices are given as estimates and may be increased/reduced based on coat condition, special handling needs, additional services requested, and or special requests made. Owner acknowledges that they may be financially responsible for damages caused to SSR property, staff, or facility. SSR is not responsible for damage or loss caused to personal items left with a pet during a stay.

3. Owner further agrees that the pet shall not leave SSR until Owner pays all charges.

4. By signing this Contract and leaving his or her pet with See Spot Run on 21, Owner certifies to the accuracy of all information given about said pet on the New Client Form. Any pet that has a known aggression issue must be under the treatment of a certified behaviorist or veterinarian behaviorist before becoming a new client. Any pet that shows aggression may be refused service for the health and safety of other pets and staff.

5. See Spot Run on 21 shall exercise reasonable care for the pet delivered by the Owner to the facility for boarding, daycare, grooming or training. It is expressly agreed by Owner and SSR that SSR’s liability shall in no event exceed the lesser of the current chattel value of a pet of the same species or the sum of $200.00 per animal boarded. The Owner further agrees to be solely responsible for any and all acts or behavior of said pet while it is in the care of SSR.

6. Owner specifically represents that he or she is the sole owner of the pet, free and clear of all liens and encumbrances.

7. Owner specifically represents to SSR that the pet has not been exposed to rabies, distemper or kennel cough within a thirty day period prior to entering SSR. Any pet that shows signs of illness during their stay may be quarantined and/or may be required to seek veterinary treatment before being allowed to return. In addition, pet’s nails must be trimmed to a safe length, if not; staff will perform a nail trim at the expense of the Owner.

8. All charges incurred by Owner shall be payable upon pick-up of pet, or when billed by SSR at address listed on file. SSR shall have, and is hereby granted, a lien on the pet for any and all unpaid charges resulting from boarding pet at the kennel. The Owner hereby agrees that in the event the boarding charges are not paid when due in accordance with the contract, SSR may exercise its lien rights upon ten days written notice given by SSR to Owner by certified mail to address shown on file. SSR may evaluate abandoned pets for adoption and re-home as necessary; the Owner specifically waives all statutory or legal rights to the contrary.

9. If pet becomes ill or if the state of the animal’s health otherwise requires professional attention, See Spot Run on 21, in its sole discretion, may engage the services of a veterinarian or administer medicine to give other requisite attention of the animal and the expenses thereof shall be paid by the Owner.

10. This Contract contains the entire agreement between the parties. All terms and conditions of this Contract shall be binding on the heirs, administrators, personal representatives and assigns of the Owner and SSR.

11. Any controversy or claim arising out of or relating to this contract, or the breach thereof, or as the result of any claim or controversy involving the alleged negligence by any party of this contract, shall be settled by arbitration in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by an arbitrator may be entered in any Court having jurisdiction thereof. The arbitrator shall, as part of his award, determine an award to the prevailing party of the costs of such arbitration and reasonable attorney’s fees of the prevailing party.

12. In any litigation arising out of this contract, the prevailing party shall be entitled to receive reasonable attorney’s fees and costs.