THE ZURI PET SPA & RESORT
New Client Information
Name:
________________________________________________________________________
Address:
__________________________________________________________________
City:
________________________________________________Zip:___________________
Phone No.:
___________________________
Mobile No.:
_________________________
Email:
___________________________________________________________________
Emergency Contact: ______________________________________Phone:_________________________________
How did you hear about The Zuri Pet Spa & Resort?
___________________________________________________________________
Pet Information
Pet Number One
Name:
___________________________
Breed: _______________________________
Sex:
Male / Female (circle one)
Spay/Neutered (circle one) Color: ______________________________
Allergies:
___________________________________________________________________
Brand of pet food your pet is eating:
____________________________________________________
Can your pet have treats?
Yes/No
Birth date:
_____/_____/_________
Where did you get your pet?
______________________________________________________
Are there any known issues?
_______________________________________________________
Has your pet been to doggie daycare?_________________If yes, Where at?___________________________________
Pet Number Two
Name:
___________________________
Breed: _______________________________
Sex:
Male / Female (circle one)
Spay/Neutered (circle one)
Color: ______________________________
Allergies:
___________________________________________________________________
Brand of pet food your pet is eating:
____________________________________________________
Can your pet have treats?
Yes/No
Birth date:
_____/_____/_________
Where did you get your pet?
______________________________________________________
Are there any known issues?
_______________________________________________________
Has your pet been to doggie daycare?________________If yes, Where at?_____________________________________
Pet Health Information
Vet Name: ___________________________________________________________________
Clinic Name: ___________________________________________________________________
Phone No.: ___________________________________________________________________
Is your pet(s) on flea control?
Yes / No
Any known medical issues?
_______________________________________________________
Is your pet(s) up to date on vaccinations?
Yes / No
How often does your pet(s) get groomed?
___________________________________________
Where is your pet(s) currently groomed?
___________________________________________
WAIVER, RELEASE, MEDICAL POWER OF ATTORNEY, AUTHORIZATION AND ACKNOWLEDGMENTS
I,
_________________________________________
the
undersigned
owner
of
a
pet(s)
named
_______________________________________ (hereinafter the “Owner”), in consideration of the services received from the Zuri Pet
Spa & Resort, hereby agree as follows:
Owner understands that all pets must be in good health. Owner will need to certify that their pet(s) are in good health and have not been
ill in the past 30 days. On admission, all pets must be free from any condition which could potentially jeopardize other guests, patrons
or pets. Pets that have been ill with a communicable condition in the last 30 days will require a veterinarian certification of health to be
admitted or readmitted. Owner hereby declares to The Zuri Pet Spa & Resort that Owner is the legal owner of the pet(s); that Owner’s
pet(s) has not been exposed to distemper, rabies, or parvovirus within the past thirty (30) days, and that Owner’s pet(s) has been
inoculated as indicated by records presented.
Owner represents that his or her pet(s) is in all respects health and has received all required vaccines (DHPPC, Rabies and Bordetella
for dogs), current flea protection (e.g., Frontline, Advantage or Revolution for dogs), and that said pet(s) does not suffer from any
disability, illness or condition which could affect said pet, other pets, or employees’ safety at The Zuri Pet Spa & Resort.
Owner will inform The Zuri Pet Spa & Resort of any medical problems or allergies that may flare up due to the stress of
grooming/boarding/daycare upon arrival. The Zuri Pet Spa & Resort will not be responsible for clipper burn and/or minor nicks resulting
from grooming of matted, neglected coats or for irritation caused by removing the coat from pets possessing mild to severe skin allergy.
We reserve the right to charge additional fees for services we consider over and above the norm covered by our standard rates, which
include, but not limited to, medicated baths, flea baths or threat to us or to other pets left in our care, whether it is an aggression problem,
health problem or parasite problem.
Owner certifies that Owner’s pet(s) has never unduly harmed or threatened anyone or any other pets. Owner expressly agrees to be held
responsible for any damage to property (e.g., kennels, fencing, walls, flooring, etc.) or cost incurred by Owner’s pet(s).
Owner expressly agrees to be held responsible for medical costs due to human injury caused by Owner’s pet(s). Owner understands that
if Owner’s pet(s) displays aggressive behavior, that for the safety and health of Owner’s pet(s) and others, Owner’s pet(s) may be
confined to a kennel or be muzzled for the remainder of his/her stay with no offset or deduction in price.
Owner recognizes that there is an inherent risk of injury or illness in any environment associated with numerous cage-less dogs in
boarding / grooming / daycare environments. Owner also recognizes that such risks include, without limitation, injuries or illnesses
resulting from fights, rough play, injury during transportation services, and contagious diseases.
While we do our very best to care for your pet, The Zuri Pet Spa & Resort cannot guarantee the health of any pet during the pet’s stay.
Some conditions are unavoidable in facilities like this, such as weight loss, hair loss, upper respiratory infections, bronchitis, diarrhea
and parasites. Owner understands that all pets admitted must be protected against communicable contagious diseases and must be free
of parasites. This will assist in providing a healthier environment for all.
If, in Owner’s absence, Owner’s pet(s) should be injured, become ill or suffer an ailment or is otherwise deemed by The Zuri Pet Spa &
Resort to require immediate medical attention, The Zuri Pet Spa & Resort, in its sole discretion, is authorized to make all health care
decisions on Owner’s behalf, and may utilize the services of a licensed veterinarian to administer medicine or give other requisite
attention to Owner’s pet(s) at Owner’s sole expense. Owner hereby indemnifies The Zuri Pet Spa & Resort, its owners, assigns,
employees, agents and independent contractors, from any action, claim, demand or lawsuit (including attorney’s fees) arising out of or
connected with the charges made by any veterinarian caring for Owner’s pet(s).
If any problem or emergency develops and it is necessary to treat Owner’s pet(s), please initial one of the following directives:
Owner agrees to be responsible for any and all charges incurred to care for my pet’s health per my choice:
______ Please treat my pet as required: If owner is unreachable.
______ Please perform only emergency and supportive care. Notify me for permission to begin any other treatment.
______ Do not perform any diagnostics and/or treatment until I am notified and consent to said treatment. I understand that
my pet’s health may be at risk until I am notified.
Knowing these inherent risks and dangers, Owner understand that The Zuri Pet Spa & Resort cannot be held responsible for any injury,
illness, or damage caused by Owner’s pet(s) and that Owner is solely responsible. Owner agrees to indemnify, release and hold harmless
The Zuri Pet Spa & Resort, it’s owners, employees and agents, from any claims for damages, all defense costs, attorneys’ fees, and
business losses resulting from any claim Owner makes or causes to be made against The Zuri Pet Spa & Resort for which it, its agents
or employees are not ultimately held to be legally responsible.
Owner hereby releases The Zuri Pet Spa & Resort, its agents, officers, sub-contractors, employees, animal owners, customers, and
potential customers of The Zuri Pet Spa & Resort from any and all liabilities, financial, and otherwise, for injuries to Owner, Owner’s
pet(s), or any other property of Owner, which arise in any way from services and/or products provided by or as a consequence of my
association with The Zuri Pet Spa & Resort.
Owner agrees to assume all liabilities and responsibilities, financial and otherwise, for the behavior and health of Owner’s pet(s). In
consideration for the services rendered by The Zuri Pet Spa & Resort, Owner waives any and all claims, actions, or demands of any
nature, foreseen or unforeseen, that Owner may have against The Zuri Pet Spa & Resort relating to the care, control, health, and/or safety
of Owner’s pet(s) arising during pick-up, transport, drop-off and stay at the facilities.
Owner understands that The Zuri Pet Spa & Resort has the right to refuse service to Owner and/or Owner’s pet(s) at any time for any
reason. Owner understands that if Owner’s pet(s) has a history of or repeatedly demonstrates aggression or biting of humans or animals,
The Zuri Pet Spa & Resort reserves the right to refuse services. Owner understands that all bites will be reported to the local authorities
as required by law.
OWNER REPRESENTS THAT HE/SHE HAS MADE FULL DISCLOSURE AND HAS READ, UNDERSTANDS AND
ACCEPTS THE TERMS AND CONDITIONS IN THIS AGREEMENT, AND ACKNOWLEDGES THAT THIS
AGREEMENT SHALL BE EFFECTIVE AND BINDING UPON THE PARTIES.
OWNER
_________________________________________
Print Name
_________________________________________
Sign Name
_________________________________________
Date