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1 ! Page 1 *Please Complete This Form* Owners Name: Address City : State : Zip : Home Phone : Business Phone : Cell Phone : Dog s Information: Name of Dog(s) : Breed(s) : Weight : Color : Birth Date : Circle where appropriate: Female or Male Spayed or Neutered Method of flea, tick, Heart-worm control: Product Name: Product Name: Date Last Given: Date Last Given: I want my dog to enjoy Playtime and Socialization Initial I prefer my dog to be exercised separately and not among other dogs. Initial Is your dog house broken? Yes No Has your dog ever had Kennel cough? Yes No Has your dog been ill in the last 30 days? Yes No Has your dog had surgery in the past year? Yes No Does your dog have any allergies? Yes No If yes, please explain: Has your dog ever attended daycare or been boarded? Yes No If yes, which kennel? Is your Dog good with other dogs? Yes No Has your dog ever exhibited aggressive behavior towards other dogs or people? Yes No If yes, please explain: Has your dog ever bitten anyone? Yes No If yes, please explain: Has your dog ever been injured as a result of being at the dog park, dog daycare or playing with another dog? Yes No If yes, please explain: Eating Habits: Page 2 Type and Brand of food How much per feeding How Often How would you characterize your dog s eating? Circle One. Fast Slow

2 Circle your dog s eating habits: Eats all food at mealtime Nibbles throughout day Goes for periods without eating Sometimes requires more palatable food to be mixed in to eat Can we give your dog treats? Yes No Medical Emergency Information: Veterinarian s Name : Phone : Address : City : 1. Vaccinations Please list the current expiration dates for the following vaccinations (required upon check-in): Rabies DHLPP Bordatella- Kennel Cough(suggested every 6 months) 2. Please describe any medical or physical problems, including allergies: 3. Emergency Contact (other than owner) : Name : Phone : Relationship : 4. Emergency Medical Care If, in our judgment, your dog requires immediate medical care and we are unable to reach you, we will take your dog to a veterinarian or animal hospital which owner is responsible for all veterinarian or animal hospital costs. By signing below, you confirm that the above is correct to the best of your knowledge, and that you will provide further information upon future visits. It is your responsibility to make sure all records are up to dated for your pet. This agreement is in effect for all services rendered by for 12 months from date of agreement. Signature Date

3 Golden Acres Farm Client Agreement page 3 ***PLEASE READ AND INITIAL EACH ITEM*** Initials reserves the right to immediately change your dog s type of boarding/daycare if we believe it is necessary to protect the health and well-being of your dog, other dogs, or our staff. Initials All dogs must be healthy, and current on all vaccinations. You will be required to bring a copy of your dog s updated vaccination records from your vet before you start boarding with us to ensure your dog s safety as well as that of our other guests. As well as a negative brucellosis test. Initials Dogs with flea or tick problems will be bathed and treated at the owner s expense. Initials Check-out time for boarders is 8-10 am on weekdays, appointment required for Saturday and no Sunday appointments. Dogs leaving after this time will be charged an additional fee. A deposit is required upon your dog s arrival. All charges must be paid in full upon pick-up of your dog. Deposit for holiday boarders is non-refundable. There is a 48 hours notice cancellation policy during non-holiday reservations, and a 5 day cancellation policy for holiday reservations. Initials The Kennel brand of dog food used is Diamond High Performance. If you are feeding any other food, we invite you to bring it with you. Changing dog food may cause severe upset stomach. Owners are welcome to bring their own bedding or toys if desired, however we cannot guarantee that they will be returned in the same condition. If you elect for us to feed your dog our Kennel brand of food, the cost per feeding is $2.00 per day. Initials will give all non-injectable medications as specified. Please make sure all medication is clearly labeled and dosage instructions are included. Initials, in an effort to make sure all rooms are clean and ready for incoming guests, maintain a checkout time of 8-10 am on the final day of the stay. Any dog not checked out by that time will be subject to a $10 late check-out fee. Initials If pet becomes ill or if state of the animal s health otherwise requires professional attention,, in its sole discretion, may engage the services of a local veterinarian or provide appropriate medical attention to the animal and any and all expenses thereof shall be paid by the owner. Initials Owner is aware that by leaving said pet at, or any other pet facility, said pet is at a higher risk of contracting canine cough and viruses. While we have taken very special care in our facility and maintaining a high level of cleanliness, no vaccine is 100% guaranteed therefor cannot be held liable for any viruses, diseases or other illnesses. Initials I understand that I am solely responsible for any harm or damage caused by my dog(s) to persons or property of the Owners, employees, licensees, invitees of, or any other pets housed or visiting while my dog(s) is/ are attending and will be required to pay for any such damage. You release, indemnify, and agree to hold and its owners harmless from any and all manner of damages, claims, loss, liabilities, costs or expenses, causes of actions 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. Owner acknowledges and understands that there are certain risks involved in pet ownership, training, and care, including, but not limited to, dog fights, dog bites to humans and/or other pets and the transmission of disease. With Owner s signature below, he/she understands the risk involved in putting his/her pet in a kennel and acknowledge and accept exclusive and sole responsibility for all medical expenses to said pet no matter the cause. Owner also authorizes the release of said pet s medical records from pet s veterinarian. By signing this contract and leaving pet with, owner certifies to the accuracy of all information given about the pet. Furthermore, owner has read and understands all procedures and policies included herein. This agreement is in effect for all services rendered by for 12 months from date of agreement. Signature Date Page 4

4 GUEST STAY REQUIREMENTS & POLICIES v Screening u Aggressive dogs are not permitted at facility. At this time, we cannot board American Terriers or any kind of Pit Bull Terrier, Chow Chow, Akita, Malamute, Doberman Pincher, Presa Canario, Rottweiler, Staffordshire bull terrier and wolf hybrids due to insurance requirements. u We do not accept unaltered males or females. Puppies under six months old do not need to be spayed or neutered. u Puppies need to be at least 16 weeks to be boarded. u All dogs must be on a leash when they enter and leave our facility. v Reservations u Please make a reservation for your dog as soon as possible especially as major holidays fill up fast. u At this time, we do not take credit cards but can be paid with cash, check or paypal at Paypal payments require an additional 3% added to payment. The payment can be mailed to us or dropped off. u A $10 per night increase will apply during major holidays. u Boarding is $20 per night. There is an $2.00 per night extra charge if we use our brand of Dog food.. u A $25 non-refundable deposit is required for all holiday boarding reservations. Holiday boarding is at least 2 days or if it fall on a weekend its for entire weekend u A $20 non-holiday, refundable deposit is required for reservations. u Reservations can be made for both non-holiday and holidays via phone at (513) u Current paperwork and vaccinations records must be on file at time of boarding. u Holidays are: Easter, Memorial Day, 4 th of July, Labor Day, Thanksgiving, Christmas eve and day, and New Year s Eve and day. u 10 % discount if multiple dogs sharing Kennel owned by the same family, No discount if each dogs needs own kennel. v Cancellations u For non-holiday reservations, please give us 48 hours notice or 50% of the original boarding fee will be required as payment. u For holiday reservations, please give us five days notice. If five days is not given, then 50% of the original boarding fee will be required as payment. v General Health u All pets at must be healthy and free of any contagious illnesses. If your pet is exhibiting any symptoms that may suggest illness such as sneezing, coughing, wheezing, runny eyes or nose, vomiting, lethargy, or diarrhea, we will not be able to admit them at our Kennel. We are happy to refer ill dogs and cats to local veterinarians that board pets. u All guests must be on an active flea and tick preventative. Dogs with flea or tick problems will be bathed and treated the owner s expense. u Our Kennel brand of dog food is Diamond High Performance Dog Food. If you are feeding your dog something different, please bring it (stored in a re-sealable container or bag) as changing food can cause severe upset stomach. If we feed your Dog our dog food, the charge is $2.00 per day. v Bedding & Toys u provides each overnight guest with comfortable bedding. You can bring something with your scent on it to make your pet comfortable.. You are welcome to bring your own treats and any toys your dog may enjoy, however we cannot guarantee that they will be returned in the same condition. This agreement is in effect for all services rendered by for 12 months from date of agreement. Client initial that read and agree to abide by above document: date: Page 5 v Kennel u Pets are watered and fed daily. Feeding time is 7 am and 5 PM each day.

5 u The Kennel is heated in the winter and air conditioned in the summer. u Please bring a leash for your pet to be left. We cannot be responsible for chewed up or lost belongings. u Kennels are cleaned daily. u Kennel sizes are 4 x 4 and limited 4 x 6. u We use stainless steel dishes and Micro-ban dishes for all kennels. v Day care u Your pet is welcome to come play with us for the day. All Requirements and policies are the same for Boarders and Daycare pets. Drop off is by appointment. Daycare pickup is 6 pm, late fee is a boarder charge and additional fees will be charged. u Fill out the same paperwork as the boarders. Leaving a leash is required u Daycare is $15 per day. See Tender Loving Care for extra charges. We do offer a 10 day pass for $125. No daycare on Weekends. v Tender Loving Care u will give all non-injectable medications as specified. Please make sure all medication is clearly labeled and dosage instructions are included. We do charge $1 per dose of Medications. u Special needs dogs need to bring their own feed in closeable container with their name on it and specific instructions. u When turning in for the night each pet will receive a treat, unless owner specifies otherwise. u We do offer extra walking, outside time and extra attention besides our normal 4-5 times outside, play-times, attention and feedings at an additional $2 per time charge. v Outdoor Play u We have 5 areas of play: 2 ½ acre play yards, a ¼ acre play yard and 2 runs. u The dogs can spend a lot of supervised play time outdoors on good weather days, being dogs unless the pet owners specifies otherwise. u There is plenty of shade, shelter, and water in all play yards. u On poor weather days, dogs have short potty breaks outside and have supervised play time in the kennel with treats, if allowed by pet owner. v Pick-up u Boarding pickup is between 8-10 am Monday through Friday, by appointment on Saturday and No Sundays. u Full Payment is due at the time of Pickup. u If pick up is after 10 am, owner will be charged for a whole day. u will not release any pet to anyone other than the owner as it is reflected on our files unless prior arrangements have been made. Payment is still required at check-out and photo ID will need to be presented. u After 14 days, dog is considered abandoned. will report any abandoned animal immediately and take appropriate action, sale of said dog or disposal of dog, if not contacted by the owner within the allowed time frame. v Our Staff u Our caring and friendly Staff is our family and friends who will give your pet the loving care it deserves at its home away from home. Our Website has pictures of the kennel, the staff (our family) who will love your pets. This agreement is in effect for all services rendered by for 12 months from date of agreement. Client initial that read and agree to abide by above document: Date: website:

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