Posh Paws Pet Spa & Resort CHECK IN DATE__________ TIME_________ CHECK OUT DATE_________ TIME_______ Last Name____________________ First Name___________________ Spouse_______________ Home Address______________________________City________________State____Zip______ Cell #________________Emergency #_________________Alt. Contact #___________________ Veterinarian______________________________________ Vet Phone #___________________ Please check ALL that apply to your pet. Aggressive Biter Neutered/Spayed Lives with another pet Destructive Jumper Shy/Nervous/Timid Chewer Allergies Medications If taking Medications, please list doses and times administered:__________________________ _____________________________________________________________________________. I hereby certify that I am the owner of _______________________, the dog(s) which will participate in Doggy Day Care and/or boarding. I understand that other dogs will attend Doggy Day Care and/or boarding and that during the course of participation, my dog may come into direct contact with all other participating dogs. I hereby certify that the above named dog has been fully vaccinated for canine distemper, canine parvo virus, canine hepatitis, canine parainfluenza and canine corona virus (DHPPC), as well as bordetella (kennel cough), and rabies. The requirements to participate in Doggy Day Care and/or boarding are DHPPC within the last year, Bordetella within the last 6 months, and rabies in accordance with local laws. I am aware that my dog may be exposed to those infectious diseases described above. However, since Posh Paws has advised me that my dog must be fully vaccinated against those diseases before attending Doggy Day Care and/or boarding, I alone assume responsibility for any such exposure. I also acknowledge that in addition to the diseases described above my dog may be exposed to other infectious diseases. However, in order for my dog to participate in Doggy Day Care and/or boarding and /or boarding, I alone assume the responsibility of such exposure to all other infectious canine diseases. I understand that in the event of injury or illness during his stay, my dog will be taken to the Vet of your choice or if after hours, to the Small Animal Emergency Clinic, unless your personal veterinarian is available at the time of the incident. Although Posh Paws associates diligently watch all dogs play, I am aware that given the sometimes-unpredictable nature of dogs, an interaction could take place between animals at the day care or unforeseen events could occur. If such an event resulted in injury to my dog, to other dogs, or to other people; I alone assume responsibility for any such injury. As to Posh Paws and its employees, I hereby waive and release any actions, causes of actions, damages, rights, claims or lawsuits which I may have for: (a) any and all personal injury or property damage which may be sustained arising out of any interaction between dogs participating in Doggy Day Care and/or boarding; and (b) any and all injury, illness or disease sustained by my dog arising out of or stemming from its participation in Doggy Day Care and/or boarding. I have read and understand this release form and I will honor and abide by the terms and conditions set forth above. Date_____________ Printed Name of Dog Owner____________________________________ Dog’s Name______________________ Owner’s Signature______________________________ Posh Paws Pet Spa & Resort Emergency Contact Information Your emergency contact should be someone local and someone that, in the event of emergency, has access to your home. Emergency Contact Name ________________________________________________ Home Phone _______________________ Work Phone _________________________ Cell Phone _________________________ Vet Information and Release Form Vet Clinic ____________________________________________________ Address ___________________________________ City ________________ State _____ Zip _______ Phone _____________________________ I understand that in the event of an emergency, Posh Paws will make every attempt to contact me. In the event that I cannot be reached, I authorize the following: In the event of illness or injury, I authorize Posh Paws to seek appropriate medical treatment for my pet. I understand that every effort will be made to take my pet to the vet clinic specified on the emergency form if the situation permits however; Posh Paws has the authority to seek treatment at any veterinary clinic. Furthermore, I agree to reimburse Posh Paws within 14 days of incident for veterinary fees and all related costs including transportation in any amount up to $_____________ (please specify dollar amount per pet. Common amounts are $200, $1000, or unlimited). This release does not expire and will remain valid for all future Posh Paws services. Client Signature _____________________________________ Date _______________ Printed Name _______________________________________ Posh Paws Pet Spa & Resort New Client Information Sheet How did you hear about us? Saw sign Facebook Google Television Flyer Web Site Referral? If so, who? _____________________________________________________________ Owner’s Last Name_______________________________ First Name_____________________________ Spouse’s Name______________________________ E-Mail Address_________________________________________________________________________ Address___________________________________________________City________________________ State_______ Zip Code________________ Cell Phone_____________________________ Home Phone____________________________________ Work Phone______________________________ Additional Phone ______________________________ Pet’s Name Age Breed Color Sex Spayed/Neutered ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ I give Posh Paws Pet Spa permission to seek emergency medical attention for my pet if it is deemed necessary. I assume all liability and financial responsibility for any and all costs involved for any medical attention sought for my pet's well-being. Grooming: I am aware that if my pet is matted Posh Paws Pet Spa may deem it necessary to "dematt" or even shave my pet. These procedures may have unpleasant consequences such as clipper/brush burn or nicks or cuts. Posh Paws Pet Spa will take all necessary care and precautions during ALL grooming services, but will not be held responsible for any side effects, injuries or medical bills incurred. Boarding: I give permission for Posh Paws Pet Spa to board my pet over night at a charge of $22.50 per day if I do not arrive by closing time to pick up my pet. . Sign Here __________________________________________ Date _______________________