veterinarian authorization - BARK AVENUE on Mercer Island LLC

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BARK AVENUE Mercer Island
7605 SE 27th S. Suites 154 -155
Mercer Island, WA 98040
206.232.2366 www.barkavenuemi.com
info@barkavenuemi.com
Dog Daycare Service Agreement
Name of Owner(s): _______________________________________Date:__________________
Name of Pet(s): ___________________________________________________________
Home Address: _______________________________City:__________Zip:________ _____
Home Phone: _______________ Work: _____________ Cell: ______________
Your e-mail Address: ____________________________________________________________
Vet: ________________________________ Vet Phone: _________________________
If unable to reach your vet in the event of an emergency, may we use another?
Mercer Island Veterinary Clinic (yes / no)
(206) 232-0333
2448 76th Ave. SE Suite 102
Mercer Island, WA 98040
Bellevue Animal Hospital (yes / no)
(425) 454-1246
10415 Main Street
Bellevue, WA 98004
Mercy Vet (yes / no)
(206) 232-7667
27017 76th Ave. SE
Mercer Island, WA 98040
Aerowood Animal Hospital (yes / no)
(425) 746-6557
2975 156th Avenue SE
Bellevue, WA 98007
Cat and Dog Clinic of Bellevue (yes / no)
(425) 641-1160
13812 NE 16t
Bellevue, WA 98005
BARK AVENUE Mercer Island Daycare Service Agreement
Page 1
Fees:
Fee/Rate Schedule: Daycare Full Day (12 hours) $30.00. (Over 6 hours up to 8 hours) $20. Half Day (6 hours) $15.00.
Two Hour Special $5. Multiple Pet (two dogs) Full Day $40.00. Multiple Pet Half Day $25.00 Multiple Special $15.00
**Prices subject to change**
The Client hereto agrees as follows:
1. BARK AVENUE Mercer Island (“BAMI”) agrees to provide services stated in this contract and checklist in a reliable
and trustworthy manner. While we always maintain staff on the premises, there may be times when no staff is
directly in contact with the dogs in the playroom. In consideration of these services and as an express condition
thereof, the Client expressly waives any and all claims against BAMI. BAMI shall not be held responsible for the
loss, injury, death of animals or loss, theft of personal items of the animals in our care. (Leashes, collars, tags, etc.)
2. The Client understands that all dogs must have a veterinarian and be current with basic vaccinations and have had
a Bordetella shot within the last 6 months.
3. No dog will be allowed to roam or allowed off leash out of the property. If the dog leaves the property, BAMI is not
responsible for the actions of that pet.
4. The Client understands that no amount of supervision, sanitation, or personalized care can prevent a dog from
catching an airborne virus and an animal can be contagious BEFORE showing any symptoms. In these situations
BAMI cannot guarantee that the dog will not get sick. The Client is responsible for any veterinarian care involving a
virus or bacterial infection. The Client understands that BAMI will provide the best possible care, never take in
knowingly sick pets, and require proof of current inoculations and Bordetella shots. BAMI will take all possible
precautions to control fleas in the environment but cannot guarantee that the pet will leave the facility without fleas.
The Client understands that the pet MUST be on some form of flea program.
5. BAMI does not diagnose, prognoses, or make therapy decisions nor does it offer veterinary services. It is always
advisable to consult the experts, your veterinarian.
6. BAMI will not daycare acutely ill animals or those with uncontrolled medical conditions (unless otherwise agreed
upon by BAMI for individual situations). We suggest the pet be boarded with a vet.
7. BAMI does not accept aggressive animals or uncontrollable animals. All animals must Spayed or Neutered before
one year in age. If the pet becomes aggressive or uncontrollable BAMI will endeavor to contact Client. However, in
absence of pet owner contact, BAMI will make decisions in their best judgment of the situation and solution.
8. BAMI will expect the Client to adhere to agreed upon fees and drop-off / pick-up schedule (by the original agreement
BARK AVENUE Mercer Island Daycare Service Agreement
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and / or adjustments agreed upon via phone and contract). If pet’s stay exceeds the agreed upon time frame due to
Clients negligence, additional fees of one half day will be charged. Abandoned animals will be taken to the closest
shelter or Humane Society at the owner’s expense.
9. DAYCARE: Normal business hours fall between the hours of 7am and 7pm weekdays.
BAMI reserves the right to deny service or terminate service because of safety concerns, financial concerns, or
inappropriate or uncomfortable situations.
10. Payment is normally expected after services or no later than 31 days of the completion of services.
11. Forms of payment: Credit / debit card, check or cash. In the event of a returned check, the Client must pay the entire
invoice and all applicable fees promptly by credit, debit or cash.
The observed holidays are: (NOTE: The Company may be flexible when conditions allow) *New Years Day *Memorial
Day *Independence Day *Labor Day *Thanksgiving Day *Christmas Day*
BARK AVENUE Mercer Island Daycare Service Agreement
Page 3
CHECKLIST: of Things to Know…
Pet’s Name:
Breed:
Age:
Birthday:
Size:
Sex:
Spay / neutered: (yes / no)
Diet considerations:
Walks & other: Required? (yes / no)
Collar / leash/ ID tags provided: (yes / no)
Personality:
Favorite toys: _____________________________________________________________________
Favorite games: ___________________________________________________________________
General temperament: _____________________________________________________________
Things to avoid: ___________________________________________________________________
Health:
Is dog healthy: (yes / no)
Drugs and directions: ____________________ Reason for drugs: _________________________
**We will check with your Veterinarian**
BASIC SHOTS current: (yes / no) **Proof required**
Flea prevention program: (yes / no) Type of program: ___________________________
Proof of Bordetella shot: (yes / no) **Proof required**
Commands: Any special or out of the ordinary commands that pet responds to:
Pet’s & Owner’s Fears: Any to be aware of and precautions to take:
EMERGENCY: Primary contact name / number /email:
Secondary contact:
“I agree all the information in this contract & checklist is factual based upon my current
knowledge.”____________________ ___(Owner’s Signature) Date:________________________
BARK AVENUE Mercer Island Daycare Service Agreement
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BARK AVENUE Mercer Island
7605 SE 27th St. Suite 154
Mercer Island, WA 98040
206.232.2366
VETERINARIAN AUTHORIZATION
During my various absences, Bark Avenue MI will be caring for my animal(s). They have
my permission to transport them to and from your office as is deemed necessary and receive
information and results.
I authorize (Vet./Dr.)____________
to treat my animal(s) and I will
be fully responsible for all fees and charges and will pay for all charges they incur on my
behalf upon my return or charge my credit card on account.
I further authorize you to give out any information about my animal(s) to Ian Bojarski,
owner of BARK AVENUE Mercer Island.
________________________________________
Owner’s Signature
______________________________________
Owner’s Printed Name & Date
BARK AVENUE Mercer Island Daycare Service Agreement
Page 5
Trial Checklist
Due to lease, insurance, city, county and state demands;
Your Best Friend must first pass a trial before joining our Pack.
Aggressive Behavior/ Sociability: 
Excessive Barking: 
Spayed/ Neutered 
Unhealthy: 
Too Young/ Too Old: 
Knowledge of basic commands: 
House broken: 
Not enjoying the experience: 
Congratulations! Your Best Friend has passed.
Sorry, but your Best Friend has not passed.
BARK AVENUE Mercer Island Daycare Service Agreement
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