T.L.C.
Doggy Day Spa
Telephone: 631-673-6476 • Fax: 631-470-2280
Doggie Day Care Client Release
Your Information:
Name:__________________________________________________________________
Address:________________________________________________________________
City:________________________________________State:__________Zip:__________
Phone: (H)____________________________
(W)________________________________
Cell:_________________________________
Vet
Information: Emergency
Contact (other
than vet):
Name:____________________________________ Name:___________________________________
Address:__________________________________ Address:_________________________________
City:__________________State:_____Zip:______ City:__________________State:_____Zip:______
Phone: (H)____________________ Phone: (H)_______________________
(W)___________________ (W)_______________________
Pet Information & Feeding Instructions:
Name - Breed –
Color Age Sex
Feeding (cups/day-Cans/Day-Times/Day)
Pet
(1)_________________________|_____|______|__________________________________________
Pet
(2)_________________________|_____|______|__________________________________________
Pet
(3)_________________________|_____|______|__________________________________________
Pet
(4)_________________________|_____|______|__________________________________________
Medical
History / Meds Instructions
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Special
Instructions:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Is
your dog allowed to have biscuits? Yes:_____ No:_____Is your cat allowed 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.
Signature:__________________________________________
Date____________
T.L.C. Doggy Day Spa Waiver
DOG BEHAVIOR AND HEALTH
I understand that T.L.C.
Doggy Day Spa reserves the right to refuse use of its facilities for dogs who,
in its sole determination are unhealthy, act aggressively, are undisciplined,
display inappropriate behavior or who may otherwise be a danger to themselves
or other animals or users. To use the facilities my dog must be spayed or neutered
if it is older than 6 months of age and must remain current with Distemper, Parvo, Rabies, and Bordatella
vaccinations(bordatella is every 6 months). If
requested to do so, I will provide T.L.C. Doggy Day Spa with an up-to-date
health certificate verifying compliance with these requirements. T.L.C reserves
the right to limit usage if I do not provide required verification, and in such
event I am not entitled to any refund or credit. I acknowledge that I undertake
responsibility for, and will not hold T.L.C. Doggy Day Spa liable for, any
illness or ailment, which my dog may incur while in the presence of other dogs
at the facility.
INJURIES
I acknowledge that dogs are encouraged to socialize and exercise at T.L.C. Doggy Day Spa and that injuries to dogs might reasonably be foreseen to result from playing and roughhousing that may occur while in the care of T.L.C. Doggy Day Spa. I agree to assume the risks and hazards that might be expected to arise from such use and the presence of and my dog’s interaction with other animals. I also agree that T.L.C. Doggy Day Spa shall not be responsible, monetarily or otherwise, for injuries to my dog which may arise in the course of play or which may be caused by the presence or actions of other dogs. I shall hold T.L.C. Doggy Day Spa harmless from, make no claim against and indemnify T.L.C. Doggy Day Spa, against any costs, damages, claims or expenses that may result from an injury to my dog or to another dog, if caused by my dog.
VETERINARY CARE
If, in my absence, my dog
should be injured or is otherwise deemed by T.L.C. Doggy Day Spa to require
immediate veterinary attention, T.L.C. is authorized to consult with my
veterinarian for treatment and guidance. If my veterinarian is unavailable,
T.L.C. Doggy Day Spa is authorized to utilize the services of any other
reputable veterinarian. I understand that I am responsible for any charges with
respect to any such veterinary care.
By signing below, I
acknowledge that I have read and accept the terms and conditions stated above.
Print- ______________________________________________________
Sign ____________________________________________
Date _________________________