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New Client Information - Welcome to the Good Dog Family!
Name
*
First Name
Last Name
Email
*
Address
*
Address, City, State, Zip
Phone
*
(###)
###
####
Emergency Contact Name
*
Someone other than yourself
First Name
Last Name
Emergency Contact Phone
*
(###)
###
####
Veterinarian Practice Name
*
Authorized Parties for Release of Pet
In case of emergency, or if you are unable to pick up your pet(s), do you designate anyone else as an authorized party for pick up?
How did you hear about us?
Dog Information
If there are multiple dogs, please separate information with a comma.
Dog Name(s)
*
Breed(s)
*
Color(s)
*
Gender(s)
*
Spayed / Neutered?
*
Yes
No
Mix (family includes both fixed and intact dogs)
Weight(s)
*
Age(s)
*
Known Behaviorial Issues
*
None
Food Aggressive
Toy Aggressive
Dog Aggressive
Human Aggressive
Other
Known Medical Issues
None
Allergies
Injuries
Medical Conditions
Other
Please elaborate if any behavioral or medical boxes were checked yes.
Agreement, Informed Consent Notice, Release, & Medical Power of Attorney
*
Terms. Good Dog Boarding & Walks is hereinafter referred to as “Good Dog”. Dogs may only be dropped off or picked up during Good Dog’s posted normal business hours. Good Dog will use its best efforts to maintain its facilities in a safe and sanitary manner. By signing this agreement, I represent that I am the legal owner/guardian of my dog, and that my dog has current inoculations including but not limited to inoculations against distemper/parvo, bordetella, and rabies. I understand and acknowledge that my dog will be kept in the company of other dogs during a stay at Good Dog. I am willingly and knowingly inserting my dog into this environment where accidents may occur. I understand that my dog must have a suitable collar or harness and proper identification tags. I give Good Dog permission to take pictures and/or video of my dog for use in its advertising and promotional materials (including but not limited to Instagram and Youtube), and any pictures/video so taken become the property of Good Dog. I understand that Good Dog may terminate my dog’s stay at any time in its sole and absolute discretion, and that if my dog’s stay is terminated I will promptly pick up my dog, or send an authorized party to do so. I understand that Good Dog’s walks, pet sitting, and pet taxi services take place outside of a Good Dog facility where my dog may be impacted by external, uncontrollable factors. I understand that daycare, boarding, grooming, walks, pet sitting, and pet taxi products/services are nonrefundable. Informed Consent Notice. Overnight boarding guests will be left unattended without an employee present at Good Dog’s facility between the hours of 7pm - 7am. Good Dog’s facility is not equipped with a sprinkler system. Good Dog’s facility is equipped with 24/7 security and fire alarm monitoring services, a fire evacuation plan into a safe holding area, and is included in Pearl’s contracted security observation route. Additional Services & Charges. I understand that if I do not provide sufficient food for my dog that Good Dog will provide its own food for a fee. I understand that some services are available upon request and for additional charges. I understand that I am responsible for all fees and charges that my dog incurs during its stay at Good Dog or during an off-site service performed by Good Dog . I understand that if I am late picking up my dog I may be charged for all additional time that my dog spends at Good Dog. Assumption of Risk. I hereby give Good Dog permission to care for my dog and to do any and all things required in the ordinary and normal course of providing such care. Good Dog may use leashes, collars, and other appropriate means of maintaining control over my dog. I understand that Good Dog is not responsible or liable for any of the following: injuries (or death) to my dog caused by other dogs (including being bitten); diseases or ailments which my dog may contract from other dogs including infections and viruses; falls; theft; collisions with vehicles; running away; natural disasters; fire; the unavailability of emergency medical care or any items necessary for the care of my dog due to circumstances beyond the control of Good Dog (including food, water, medicine, and electricity); the negligence or deliberate acts of third parties; or injuries or death to my dog caused by themselves including but not limited to hanging themselves, ingesting foreign objects, chewing themselves, chewing foreign objects, or running away. I understand that Good Dog is not responsible for any personal property left with Good Dog, including but not limited to beds, blankets, clothing, bowls, food, collars, leashes, or toys. Veterinary Care. If, in my absence, my dog should be injured, appears sick, or otherwise requires immediate veterinary attention as determined by Good Dog in its sole and absolute discretion, I hereby authorize Good Dog to consult with any veterinarian for treatment or guidance. I authorize Good Dog to utilize the services of any veterinarian selected by Good Dog. I understand that I am responsible for any charges incurred with respect to any such veterinary services. I name Good Dog as my attorney-in-fact in my name to accomplish the foregoing. Release of Liability and Indemnification. I hereby release Good Dog, its owners, employees, contractors, or any other persons or entities involved with the services provided by Good Dog from all actions, suits, or claims for injury, loss or damage regardless of the cause (with the sole indiscretion of intentional wrongdoing of Good Dog). I also release the owner of the facility (“Owner”) which Good Dog occupies from all actions, suits or claims for injury, loss or damage regardless of the cause (with the sole indiscretion of intentional wrongdoing of the Owner). I understand and acknowledge that dogs can be extremely unpredictable and may cause damage to themselves, other dogs, persons or property for which Good Dog could be liable. I agree to indemnify and hold harmless Good Dog and Owner for any and all losses, liabilities, demands, expenses, claims and suits, including any legal, veterinary or other fees Good Dog or Owner may incur as a result of any damage caused by my dog, and I agree to defend Good Dog and Owner against such. I further understand that if my dog causes injury to another dog / person that I am responsible for all corresponding veterinary / medical care expenses. It is the intention of the parties that the foregoing releases shall be effective as a bar to all actions, claims, losses, liabilities, damages, or costs, of any kind or nature, known or unknown, foreseeable or unforeseeable, arising out of the performances of Good Dog’s services. The parties expressly agree that this release of liability and indemnification shall be given full force and effect in accordance with each and all of its terms and provisions. I understand that this Agreement is a contract between Good Dog and myself, and that it contains an informed consent notice, power of attorney, release of liability and indemnity. If any portion of this Agreement is deemed unenforceable, all other portions shall be given full effect to the extent possible. In the event of a dispute between the parties, the prevailing party shall be entitled to recover all costs and expenses incurred therein, including attorney’s fees. This Agreement contains the complete understanding of the parties and supersedes all prior representations and understandings, whether oral or written. This Agreement may be modified only by a writing signed by both parties.
Agree
Signature
Typing your name will serve as your signature.
Thank you!