Puptown Lounge Client Profile Please complete fully for our permanent records Prior to subsequent visits – Please let us know if any of this information changes Client Name ___________________________________________________________________________ Address ______________________________________________________________________________ City ____________________________Zip Code _____________ Wk Phone _______________ Hm Phone _________________________ Mobile Phone_________________________ Other_______________________ E-mail ___________________________________________ Emergency Contact _______________________ Relationship _____________ Phone ______________________ Pet Profile(s) Pet 1 Name _____________ Age ___ Sex M/F? ____ Spayed/Neutered?__________ Species (Dog, Cat, Etc.)________ Breed ______ Pet 2 Name _____________ Age ___ Sex M/F Altered? ____ Species ________ Breed ______ Pet 3 Name ______________ Age ___ Sex M/F Altered? ____ Species _______ Breed ______ Food: Type / Amount / How Mixed / Feeding Schedule / Any Special Instructions Food 1: ___________________________________________________________________________ Food 2: ___________________________________________________________________________ Food 3: ___________________________________________________________________________ Favorite Treats: how often/when: __________________________________________________ Favorite Activities / Toys: _____________________________________________________________ Training/Obedience/Commands: _________________________________________________________ Puptown Lounge Is there a magic word for pee/poop?________________________________________________ How is your dog on lead?_________________________________________________________ Medications and instructions to administer: ______________________________________________________________________________ ______________________________________________________________________________ Are vaccinations current? Yes ____ No ______ If no please explain: _____________________________________________________________________________ ______________________________________________________________________________ Temperament/attitude toward strangers, check all that apply: Excited __ Friendly ____ Aloof ____ Cautious ______ Stressed ____ Scared/Defensive _____ Aggressive ____ Indifferent ______ Dog/dog social skills/attitude; dog park or day care experience? ______________________________________________________________________________ Has pet ever bitten anyone or acted aggressively toward anyone? Yes __ No ____ If yes please explain: ______________________________________________________________________________ Physical conditions or problems to watch for/be aware of/house training or reliability of bladder/bowel control:___________________________________________________________ ______________________________________________________________________________ Please describe your pets’ normal eating/exercise/elimination routines ______________________________________________________________________________ ______________________________________________________________________________ Puptown Lounge Veterinary Information Name of practice/hospital __________________________________________ Primary vet’s name ________________________________________________ Address ___________________________________City __________________ Phone ____ ____ ______ In the event of a health emergency, Puptown Lounge may exercise discretion in seeking veterinary care, preferably to the above named veterinarian, should time allow. If our primary veterinarian is not available, or it is after normal business hours, Puptown Lounge has permission to take my pet to the nearest emergency animal clinic. I understand that I am responsible for the entire cost of care. Pet Guardian ____________________________________ Date ____________ (Signature) PLEASE ATTACH A COPY OF YOUR PETS’ MOST RECENT VACCINATIONS Puptown Lounge RULES AND REGULATIONS OF PUPTOWN LOUNGE 1. Boarding your pet at Puptown Lounge includes group socialization play time which could expose your pet to injuries and virus/disease be transmitted. I also understand that Puptown Lounge has daily cleaning and weekly disinfestations routines to prevent spreading virus/disease. 2. All animals must be spayed or neutered to participate in day care activities. 3. Puptown Lounge requires proof of vaccination against Rabies and Bordetella (kennel cough). Rabies is required for all pets and Bordetella shots are only required for dogs. Notice of any recent or ongoing medical conditions or issues must be provided to Puptown Lounge in writing prior to your pet’s stay. 4. Puptown Lounge provides supervision at all times when your pet is together with other animals in the facility to prevent accidents that could cause injuries to your pet. If confirmed that injury was caused because Puptown Lounge did NOT provide proper supervision and care, Puptown Lounge will be responsible for veterinarian expenses. 5. Puptown Lounge will attempt to contact you in an event of an accident or sickness at the phone number provided at the time of the reservation. If you cannot be reached at that number, we will contact your veterinarian at the facility you have provided. In case of extreme urgency, Puptown Lounge will transfer your pet to its on-call veterinarian facility. You will be responsible for any extraordinary expense incurred by Puptown Lounge as to your pet, such as veterinarian costs. These expenses do not include ordinary expenses such as your pet’s food and water. In the unlikely event of your pet’s illness, injury, or loss caused by Puptown Lounge, Puptown Lounge’s liability is limited to your economic loss. 6. If your dog displays aggressive behavior, for the safety and health of your dog and others, your pet may be confined to a kennel or be muzzled for the remainder of his/her stay with no offset or deduction in price. Puptown Lounge assumes no responsibility for harm caused by your pet to a third person or other animal. You will be solely responsible for any harm caused by your pet to any other person or animal while on Puptown Lounge’s property.