DENEGAR KENNELS BOARDING/ PET SHUTTLE

803-642-7909 OR TOLL FREE 1-866-962-PETS

Owner’s Name:_______________________________________________

Address______________________________________________________________

City____________________________________State:______________________

Zip:________ Home Phone: ___________________________________

Work or Cell Phone:________________

E-mail:_ _________________________________

Pet’s Name:______________________________________

Breed or type:_______________________________________

Weight: ___________________________

Color: ____________________________

Birth Date:________________________

Circle one of the following: Neutered Male / Spayed Female

Flea Control:________________________________________________________

Special instructions for your caged pets

_____________________________________________________________________

_____________________________________________________________________________.

Is your pet housebroken / litter box trained? Yes _____ No _____

Has your pet ever had Kennel Cough? Yes________ No _____

Does your pet cough, sneeze, wheeze or exhibit any asthmatic symptoms? Yes /No

If yes, how long have symptoms been present?

____________________________________________________________________

Has your pet ever been boarded or attended day care? Yes _____ No

Has your pet ever bitten a person? Yes _____ No _____

Has your pet ever exhibited aggressive behavior towards people or other pets?

Yes _____ or No______ If yes, please explain below…

_____________________________________________________________________

Has your pet ever been bitten, abused or attacked by another animal?

Yes ____________ No _________

Explain:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Medical and Emergency Information

Vet or Clinic_________________________________________________________________

Address________________________________________Phone:________________

City: ____________________________________________

State: __________________________ Zip:______________

Vaccinations: Please list the most recent date of the following vaccinations:

Dogs: Rabies __________ DHLP __________ Parvo __________

Bordetella __________

Cats: Rabies ___________ FVRCP ___________

Feline Leuk Testing ___________

Please describe any medical or physical problems:

_____________________________________________________________________

________________________________________________________________________________________________________________________________________

3. Emergency Contact (if other than Owner:) Name and Phone#

_____________________________________________________________________

Please initial beside each term to accept it.

4. Emergency Medical Care, If, in our judgment, your pet requires medical care and we are unable to reach you, please indicate below whether you want us to take your pet to a veterinarian or animal hospital.

YES _____ By checking “YES”, you agree to be solely responsible for the payment of all medical bills for your pet, and you release Denegar Kennels, its officers, directors, agents and employees of and from any and all responsibility for, or claims, damages, debts, arising out of or related to such medical care, including, but not limited to, transportation to/from the veterinarian clinic

and choice of veterinarian or animal hospital.

NO _____By checking “NO”, you agree to release Denegar Kennels, of and from any and all responsibility for or claims, damages, debts; arising out of, or related to Denegar Kennels not providing or obtaining medical care for your pet, and you acknowledge that Denegar Kennels is not required to give any medical aid.

Note: By checking no, you are asking us not to take your pet for medical care, other than what we can provide here at our kennels.

5. Pick-up of your pet: Denegar Kennels will only release your pet to:

____________________________________________________________________

______By checking here, you may verbally (by telephone) or in writing (by facsimile or otherwise) request that Denegar Kennels release your pet to someone other than the person(s) listed above, and you release Denegar Kennels of and from any and all responsibility for releasing your pet to any person to be authorized by yourself.

Please list any special instructions here:

___________________________________________________________________

_____________________________________________________________________

______ Denegar Kennels reserves the right to immediately change your pet’s type of boarding/day care if we believe it is necessary to protect the health and well-being of your pet, other‘s pets, or our staff.

______Denegar Kennels cannot guarantee that toys, blankets, or beds will be kept in the same condition as brought in.

______All pets must be up to date on all vaccinations!

Denegar Kennels reserves the right, without notice, to adjust its fees for services.

______I understand that Denegar Kennels will not be held accountable by me or any party with an interest, in my pet, if something were to happen during transporting this animal to or from our kennels. I understand that this is an acceptable risk taken by me, and I will be required to sign a request and release, when asking for my pet to be picked up or delivered.

By signing below, a. You indicate your agreement with all the terms hereof. b. You authorize Denegar Kennels to obtain medical and vaccination records for your pet from the veterinarian listed above and you hereby authorize your veterinarian to provide these records to Denegar Kennels. c. You release, indemnify and hold Denegar Kennels harmless from any and all manner of damages, claims, losses, liabilities, costs, or expenses, causes of action or suits, whatsoever in law or equity (including, without limitation,

attorney’s fees and related costs) arising out of or related to the services provided by Denegar Kennels, except, those which may arise from the sole gross negligence or intentional and willful misconduct of Denegar Kennels.

Including, without limitation;

(I) any inaccuracy in any statement made by ourselves or information provided by you to Denegar Kennels.(II) your pet, including, but not limited to, destroys property, bites, and has a part in the transmission of disease, III) and action by yourself which is in breach of the terms and conditions of this agreement.

d. This Agreement covers the current relationship between Denegar Kennels and yourself. Each time you bring your pet to Denegar Kennels, you affirm the terms of this agreement and the truthfulness and accuracy of all statements you make in this agreement.

PLEASE READ: You are charged for the day you come in, (WE CHARGE PER 24 HOUR PERIOD, WITH SPECIAL RULES ON SUNDAY) Example: You drop off at 2pm, if you pick up the next day by 2pm, that’s one day.

On Sunday, regardless of previous drop-off time, you are charged for the day. No exceptions!

OUR BUSINESS OFFICE IS CLOSED ON SUNDAY. THE ONLY PICK-UP OR DROP-OFF TIME WILL BE BY APPOINTMENT ONLY. THIS IS NO PROBLEM AT ALL, BUT REMEMBER..YOU ARE STILL CHARGED FOR SUNDAY!

Signature: ________________________________________________________

Date:______________________

COMPANY USE ONLY: Employee’s name/initials:___________

THANK YOU AND WE LOOK FORWARD TO PROVIDING YOU WITH THE BEST SERVICE POSIBBLE! FEEL FREE TO STOP BY AND VISIT OUR KENNELS ANYTIME! THANK YOU, PAULA DENEGAR AND THE STAFF AT DENEGAR KENNELS