Services Agreement

Pet Parent Name *

First Name

Last Name

Phone *

(###)

###

####

Pet Parent Name

optional

First Name

Last Name

Phone

optional

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

Vetrinary Hospital Phone Number *

(###)

###

####

Did you call to give permission for treatment? *

Yes

Did you fill out a pet information disclosure for each pet? *

Yes

Please check any true statements below: *

The above listed pet owners are the sole owners of this pet.

Your pet is current on rabies, distemper and Bordetella vaccines. We also encourage leptospirosis vaccine.

Your pet is in good health and has been for the past 4 weeks.

Your pet obeys basic commands such as sit, stay, come and no. (Indicate details below)

Your pet is not nursing puppies.

Your pet has no known aggression towards other dogs, people or other animals. (hackles, growls, lunges, air snaps or bites)

Your pet has not been declared dangerous, potentially dangers or vicious by any other agency.

Your pet is not a trained guard or protection dog.

You understand that if your pet becomes aggressive towards other dogs or people during his/her stay with us, we have the option of placing your pet in another safe facility at your expense.

I have read and agree to the TERMS & CONDITIONS. *

READ ALL TERMS & CONDITIONS IN A NEW WINDOW HERE.

Agree

I acknowledge an e-signature is legally valid. *

Agree

Date *

MM

DD

YYYY