Form

Owner's Full Name*

First Name Last Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number (Home)*

- Area Code Phone Number

Phone Number (Cell)*

- Area Code Phone Number

Phone Number (Work)*

- Area Code Phone Number

E-mail*

Vet Information

Vet Office Name*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

- Area Code Phone Number

Emergency Contact Information

(Other than your vet)

Full Name*

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number (Home)*

- Area Code Phone Number

Phone Number (Work)

- Area Code Phone Number

Phone Number (Cell)*

- Area Code Phone Number

Pet Information

Pet's Name, Breed, Color, Age (Birthday if you know it)

Medical History

Medications

Special instructions for the care takers

Is your pet(s) allowed to have treats?

Yes No

As owner of the above said pet(s), I hereby give consent for emergency medical care as prescribed by a duly licensed veterinarian. This care may be given under whatever conditions are necessary to preserve life, limb or well being of my pet.

Initial here for electronic signature consent.*

Is your dog a rescue or shelter dog?

Yes No

Has your dog been in daycare before?

Yes No

If your dog has been to daycare; when, where, and what was the reason for leaving?

Has your dog been socialized with other dogs?

Yes No

Has your dog been socialized with men? Women?

Women Men Both

Is your dog aggressive with strangers?

Yes No Unsure

Is your dog aggressive on walks towards people?

Yes No

Is your dog aggressive towards other animals?

Yes No

If your dog is aggressive towards other animals, please give specifics. (i.e. Cats, Male dogs, puppies, small breed dogs, etc.)

Is your dog spayed or neutered?

Yes No

If your dog is not "fixed," please give reasons." (Medical issues, not old enough, etc)

Does your dog have allergies?

Yes No Unknown

Please list allergies:

Has your dog been in training classes and/or private lessons?

Yes No

If your dog has been through training, please tell us who trained the dog, when, and durration of the training.

Please check all which applies to your pet.

is there anything else DogWatch caregivers need to know about your dog?

How did you hear about us, so we can thank them.

Do you have your pets shot records on your computer? if so, feel free to send them using this option.

Upload a File

I understand and assume the possible risks inherent to all dog/cat-related activities

involving my pet while he or she is staying at DogWatch Doggie Day Care and

Boarding. I further understand that this Release and Hold Harmless Agreement has no

time limitation and will remain in full force and effect as long as my pet participates in

either day care or boarding at DOGWATCH.

I do hereby agree to hold harmless and indemnify Richard Wilkins and Hermine Wilkins,

individually and as principals of DOGWATCH, any and all persons who might assist in

the care of my pet, or from any claim for damages and/or injuries to my pet and property.

I further release them from any liability or responsibility for any accident, injury, or

illness to any pet owned by me while said pet is at DOGWATCH.

Although we watch the dogs carefully, and do not take aggressive dogs, day care can be

hazardous due to all the dogs playing together. We make every effort to curtail

rambunctious activity, but cannot be held responsible for injuries that may occur.

In the event my pet becomes ill or in need of medical attention, I give DOGWATCH

permission to administer aid and /or to use any available veterinarian, should my

veterinarian not be available. Any expenses so incurred shall be paid by me, the pet

owner, in addition to the fees incurred for services provided by DOGWATCH

Pets arriving with fleas and/or ticks will be bathed at the discretion of DOGWATCH’S

staff, at the Owners expense. Also, any dog arriving that is in need of a bath will be

bathed at DOGWATCH’S discretion, at the Owner’s expense.

By signing this form, you acknowledge that you understand and accept the terms and

conditions set forth by this agreement.

By initial and typing my name in the boxes below, I, the pet owner, use that as my electronic signature. *Dogwatch may have you sign this release in person.

Do you agree to all the above stated?*

Yes No

Full Name*

First Name Last Name

Initial here*

Today's Date*

Month Day Year

Enter the message as it's shown*

Client Release Form

Additional Information About Your Pet

DogWatch's Release and Hold Harmless Agreement