Pet Name:
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Breed or Description:
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Sex:
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Neutered/Spayed:
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Date of Birth:
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Weight
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Color
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Gets Along With Other Dogs:
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Gets Along With People:
Please check all that apply:
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Food Brand/Feeding Instructions:
Medications/Instructions:
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Check any that have occurred in the last 6 months:
Please indicate preventative being used:
Guardian Name:
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First Name
Last Name
Address:
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email:
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Home Phone:
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(###)
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Cell Phone:
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(###)
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Work Phone:
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(###)
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Emergency Contact Name and Number:
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Veterinarian Name/Number/Address:
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Name and Phone Number of Animal Hospital:
Services Interested In:
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Other Services Interested In:
Owner Agreement:
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I, the above mentioned owner, hereby certify that my dog (s) ,as indicated above, is/are in good health, have not been ill with any communicable diseases or parasites in the last 30 days, and have not harmed or shown aggressive or threatening behavior towards any person or any other dog. I also have read and understand and agree to the following:
1. I understand that Pawsitively Love® is an open-play environment and because of this there are inherent risks, which even when closely monitored, may result in the following: a. Transfer of a communicable illness such as, but not limited to, "kennel cough," also known as the Bordatella virus, "puppy warts" also known as the canine papilloma virus, or parasites; b. Injuries, usually benign, such as broken nails, sore pads, puncture wounds, abrasions and cuts, particularly in shorter coated breeds, etc.; c. Behavioral problems;
2. If health or behavioral problems develop with my dog(s), that these will be treated as deemed best by the staff of Pawsitively Love® within their sole discretion, and that I assume full financial responsibility for any and all expenses involved. Pawsitively Love® and their staff will not be liable for any health or behavioral problems that develop in my dog(s), and I hereby release them of any liability of any kind whatsoever arising from my dog(s) attendance and participation at Pawsitively Love®.
3. I am solely responsible for any harm, including to any other dog(s), to the employees or invitees of Pawsitively Love®, or to the equipment, physical plant, or other property of Pawsitively Love®, caused by my dog(s) while my dog(s) is/are attending Pawsitively Love®. Photographs or other graphic, sound, or other image, likeness, recording, etc., may be made of my dog(s) by Pawsitively Love® and that such may be used for any purpose without compensation, and I release to Pawsitively Love® all rights that I may possess or claim to such image, likeness, recording, etc.
4. Payment is expected when services are rendered. If any amounts remain due after thirty days, Pawsitively Love® reserves the right to impose interest at the rate of 1.5% per month until paid. If Pawsitively Love® pursues collection proceedings, I will pay reasonable attorneys fees and costs of collection.
5. I have received, read, understood and agreed to the terms outlined in the Pawsitively Love® Enrollment Form and Owner Agreement, which are made part of this agreement, and I have read and understood all terms of this agreement.
6. By entering my full name below, I am acknowledging that I have read, understand and agree with the above. I understand that my signature or typewritten name in the field below constitutes my electronic signature, which is equivalent to my legal handwritten signature.
Electronic Signature:
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Date:
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MM
DD
YYYY
