DOG Agreement

6455 ANDERSON WAY – MELBOURNE, FL – 32940
Phone: 321.752.9323 – Fax: 321.806.6503
Email: tpwmelbourne@gmail.com

CLIENT'S PROFILE

FIRST NAME *

LAST NAME *

STREET ADDRESS *

APARTMENT, SUITE, ETC. *

CITY *

STATE/PROVINCE *

ZIP / POSTAL CODE

HOME PHONE *

WORK PHONE *

CELL PHONE *

EMAIL ADDRESS *

EMERGENCY CONTACT INFORMATION (FAMILY OR FIRENDS):

NAME

HOME PHONE

WORK PHONE

CELL PHONE

PLEASE LIST ANY OTHERS WHO HAVE PERMISSION TO PICK UP YOUR DOG(S)

DOG'S PROFILE:

DOG'S NAME *

BREED

COLOR

BIRTHDAY

AGE

WEIGHT

GENDER

NEUTERED?YESNO

SPAYED?YESNO

TYPE OF FOOD *

HOW MUCH PER FEEDING? *

FEED HOW MANY TIMES PER DAY? *

DOES YOUR DOG SUFFER FROM ANY ALLERGIES? *YESNO

ALERGIES:

DESCRIBE YOUR DOG'S TEMPERAMENT

It is my opinion that my dog is of adequate health to participate in services provided by THE PET WAGON.

YOUR VETERINARIAN'S NAME:

ADDRESS

APARTMENT, SUITE, ETC

CITY

STATE / PROVINCE

ZIP / POSTAL CODE

PHONE

Bring in a copy of your recent vaccination records or have your veterinarian fax them to THE PET WAGON HOTEL. Dogs must be current on:

DISTEMPER - PARVO - BORDATELLA - RABIES

First and foremost, the safety and wellbeing of your dog(s) is of the highest importance. Ensuring that your dog(s) remains safe and well cared for is our first responsibility and as such we take it very seriously. We do our best to have our guests screened for pre-existing health conditions but some factors may be beyond our control. In the event that a medical emergency arises while a dog is at THE PET WAGON HOTEL or participating in a service that we provide, it is imperative that we are immediately able to get them medical treatment at the closest veterinarian. Your dog will be rushed to the closest available facility for treatment and you will be notified. This form will expedite the process of your dog receiving medical treatment. You will be contacted again after your dog receives medical attention.
I understand that in the event of a medical emergency, which THE PET WAGON HOTEL at its sole discretion deems to need the immediate attention of a licensed veterinarian. I authorize THE PET WAGON HOTEL to seek medical attention at the closest available veterinary facility.
I give permission to the attending veterinarian to diagnose and treat my dog(s).
I further agree that I am financially responsible for any medical treatment my dog(s) receives as a result of a medical emergency.

INITIALS *

This is a contract between THE PET WAGON MELBOURNE and dog owner(s) for any service provided here.

1. THE PET WAGON MELBOURNE has relied upon my representation that my dog is in good health and has not been exposed to rabies or distemper within a thirty day period prior to any stay.
2. My dog has not injured or shown aggression or threatening behavior towards any person or dog.
3. I understand that THE PET WAGON MELBOURNE, their owners, staff, partners and volunteers will not be liable, financially or otherwise for injuries to my dog, myself, or any property of mine while my dog is participating in services provided by THE PET WAGON MELBOURNE I hereby release THE PET WAGON MELBOURNE of any liability of any kind arising from my dog(s) participation in any and all service provided by THE PET WAGON MELBOURNE. Unless arising from negligence on the part of THE PET WAGON MELBOURNE proven in a Brevard County FL court of law.
4. I understand and agree that any problems with my dog, behavioral, medical or otherwise will be treated as deemed best by the staff of THE PET WAGON MELBOURNE in their sole discretion and in what they view as the best interest of the dog. I understand that I assume full financial responsibility and all liability for any and all expenses involved in regards to the behavior and health of my dog.
5. I understand that there are risks and benefits associated with group socialization of dogs. I agree that the benefits outweigh the risks and that I accept the risk. I desire a socialized environment for my dog while attending services provided by THE PET WAGON MELBOURNE and while in their care, I understand that while the socialization and play is closely and carefully monitored by THE PET WAGON MELBOURNE staff to prevent injury, it is still possible that during the course of normal play, my dog(s) may receive minor nicks and scratches from roughhousing with other dog.
6. I understand by allowing my dog(s) to participate in services offered by THE PET WAGON MELBOURNE, I hereby agree to allow THE PET WAGON MELBOURNE to take photographs or use images of my dog(s) in print form or otherwise for publication and/or promotion.
7. I understand that I am solely responsible, financially and otherwise, for any harm or damage caused by my dog(s) while they are attending any services provided by THE PET WAGON MELBOURNE.
8. I understand that if my dog is not picked up on time or by a date specified in a separate agreement, I hereby authorize THE PET WAGON MELBOURNE to take whatever action is deemed necessary for the continuing care of my dog. I will pay THE PET WAGON MELBOURNE the cost of any such continuing care. I understand that if I do not pick up my dog, THE PET WAGON MELBOURNE will proceed according to the guidelines provided by FLORIDA Abandonment of animals by owner; procedure for handling. I also acknowledge that I will be fully responsible for all attorney fees and associated costs if I abandon my dog.
9. I agree, if my dog shows any signs of fleas or ticks during their stay, that THE PET WAGON MELBOURNE may bathe my dog and I will be charged accordingly.
10. I agree to pay THE PET WAGON MELBOURNE all charges for any service requests or necessary procedures for my dog before he/she may leave the premises.

INITIALS *

GROUP PLAY / COMMINGLING OF DOGS

I allow my dog/s to participate in group play. I understand that there are risks and benefits associated with group socialization of dogs. I agree that the benefits outweigh the risks and that I accept the risk. I desire a socialized environment for my dog while attending services provided by THE PET WAGON MELBOURNE and while in their care, I understand that while the socialization and play is closely and carefully monitored by THE PET WAGON MELBOURNE staff to prevent injury, it is still possible that during the course of normal play that my dog get injured. I understand that if at any time I do not wish my dog to participate in group play I must notify THE PET WAGON MELBOURNE in writing.

Name dog/s allowed for group play:

If you wish your dog NOT to participate in group play, your dog/s will be let out individually:

Name dog/s NOT allowed for group play:

Would you allow any of the dogs listed above (same family dogs only) to participate in activities together?YesNo

INITIALS *

Yes, I agree to the terms and conditions.