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3606 NE Columbia Blvd. Portland OR 97211 email: staypetreservations@gmail.com Phone: 503-288-7829 Fax: 503-288-8374 Owner Information Name Address City, State, Zip Email Cell phone Work Phone Home phone Additional people that can pick up your dog: Emergency Contact Name Address Home phone Cell phone Pet #1 Information Name Breed Description Sex: Male Neutered Female Spayed Birthdate Weight Microchip # License # How long have you had your dog? Pet #2 Information Name Breed Description Sex: Male Neutered Female Spayed Birthdate Weight Microchip # License # How long have you had your dog? Pet #3 Information Name Breed Description Sex: Male Neutered Female Spayed Birthdate Weight

Microchip # License # How long have you had your dog? Veterinary Information Clinic name Doctor City, State Phone VACCINE HISTORY Dates of last vaccinations: (Proof must be provided) DHLPP Bordetella Rabies HEALTH Pet # 1 Medical history (illness, injury, surgery, skin conditions, etc.) Medications? How much? How often? Has your dog had a problem with fleas? When? Current flea treatment (required): Date given Allergies? Any restrictions need to be placed on your dog s activities or movements? Does your dog have any sensitive areas on his/her body? What brand of food does your dog eat? (For boarding clients) Does your dog have any food allergies/sensitivities? Describe reaction? _ Pet # 2 Medical history (illness, injury, surgery, skin conditions, etc.) Medications? How much? How often?

Has your dog had a problem with fleas? When? Current flea treatment (required): Date given Allergies? Any restrictions need to be placed on your dog s activities or movements? Does your dog have any sensitive areas on his/her body? What brand of food does your dog eat? (For boarding clients) Does your dog have any food allergies/sensitivities? Describe reaction? _ Pet # 3 Medical history (illness, injury, surgery, skin conditions, etc.) Medications? How much? How often? Has your dog had a problem with fleas? When? Current flea treatment (required): Date given Allergies? Any restrictions need to be placed on your dog s activities or movements? Does your dog have any sensitive areas on his/her body? What brand of food does your dog eat? (For boarding clients) Does your dog have any food allergies/sensitivities? Describe reaction? _ Would you like your dog to participate in our social dog playgroups? Dogs participating in group play must successfully complete our evaluation process, and be spayed/neutered by roughly 7 months of age. These dogs should be comfortable in a group of 15 or more dogs. Please keep in mind large dogs playgroups can be 30+ dogs. Yes, include my dog in group play: Pet #1 Pet #2 Pet #3 No, do not include my dog in group play: Pet #1 Pet #2 Pet #3

BEHAVIOR/PERSONALITY Please check all that apply to your dog s personality: Happy Playful Separation Anxiety Worried Barks a lot Nervous Curious Rowdy Chews Escape Artist Toy/object Possessive Herder Dog Aggressive Social Butterfly Sweet People Aggressive Shy Cuddly Does your dog exhibit food aggression/guarding behavior? Y N Does your dog have separation anxiety? Y N If yes, please explain behaviors exhibited (barking, whining, chewing, destructive, etc ) Is your dog an escape artist? Y N If yes, please describe behavior (fence jumping/climbing, digging, etc ) Does your dog exhibit any undesirable behaviors? (poop eating, jumping up, etc.) Y N Any places your dog does or does not like to be touched? Are there any people your dog automatically fears or dislikes? Y N Has your dog ever growled, lunged at or bitten any one? Y N If yes, please describe the circumstances

Does your dog ever bark or growl at anyone passing outside your home or yard? Y N How does your dog react to children? Is your dog afraid of any specific items or noises? How does your dog react to strangers coming into your home or yard? Is there any breed or size of dog that your dog fears or dislikes? Y N How does your dog react to puppies? Has your dogs ever been in a fight or been bitten/attacked by another dog? Y N If so, please describe what happened Does your dog go to dog parks? Y N How does he/she do? How is your dog with large dogs? Small dogs? Does your dog play with any toys? Y N If yes, what kinds of toys does your dog like and what games does he/she play? Has your dog done daycare and/or boarding before? Y N If yes, when and where? Has your dog ever had any formal obedience training? Y N If yes, when and where? What commands does your dog know? Is your dog crate trained? Y N Other comments about your dog, which you feel, might be helpful:

Policies and Procedures (Please carefully read and agree to the following) 1. All dogs must be up-to-date on vaccinations. Owners must submit written proof that dogs have received the required vaccinations within the specified time period recommended by a veterinarian. All dogs must be spayed or neutered by roughly 7 months of age. 2. Any dog with a communicable disease in the past month may require veterinarian documentation of good health before it is admitted. 3. Dogs must have a current daycare/boarding application on file. All dogs must display health and temperament characteristics that are conducive to a fun, safe daycare/boarding environment. We reserve the right to refuse initial service or terminate service at any time without prior notice and at our sole discretion. Reservations are required. Reservations will be dependent on space availability. Preference will be given to dogs with regular standing reservations. 4. Payments in full for all charges incurred on behalf of a dog are due upon pick-up from daycare or boarding. A deposit or prepayment may be required for some services. 5. In the event a dog requires emergency veterinary care while at STAY PET HOTEL, it will be handled as deemed best by management. The dog owner agrees to assume full financial responsibility for any expenses involved. If it is determined that your dog s illness is contagious, the dog will be isolated or other arrangements will need to be made for his/her care until no longer contagious. 6. Although all dogs are evaluated for temperament before coming for daycare or boarding, skirmishes and correction bites may still occur. Individual owners will be responsible for their own dog s medical expenses resulting from such an occurrence. 7. All dogs that are going to be staying overnight must have successfully passed a temperament assessment before their first night of boarding. 8. Boarding dogs must be checked out by 12pm on the last day or an $18 daycare charge will be applied. Daycare dogs must be picked up before closing. 9. Overnight charges are separate from daycare packages. Daycare packages cannot be used toward overnight boarding charges. 10. Reservations are required for each stay. 11. Cancellation policy please call to cancel as soon as you know you will not be bringing your dog for boarding. 48 hours advance notice is required to avoid being charged for your stay. 12. Even though all dogs attending our daycare/boarding must receive their Bordatella vaccination every 6-12 months, there is still a possibility they might contract a different strain of kennel cough. 13. While boarding your dog, it is important to keep him/her on the same food they are fed regularly at home. Sudden changes in food can lead to diarrhea and discomfort. Therefore, it is necessary for you to bring enough his/her regular food to last the entire stay. If you forget their food or prefer that they eat ours, there will be a $1/day food charge. 14. Sometimes during play a dog will get its teeth caught in another dog s collar, therefore all dogs will be collarless while in our facility.

15. Active dogs may get friction blisters on the pads of their paws from the rubber mats in daycare on their first or second visit. We monitor the activity of these new dogs and give them frequent rest periods in an attempt to avoid this but it may still happen. We have not yet seen blisters that needed to be attended by a veterinarian but we will monitor them should this happen during their stay and treat them as deemed necessary including veterinary care should it become necessary. Agreement and Release 1. I verify that my dog is healthy, has the required vaccinations on file, is free of sickness or disease and has not harmed or shown aggression towards people or other dogs. I agree to arrange to have my dog picked up if contagious illness is suspected. 2. In the event that I cannot be reached by phone, I agree to allow the management/staff at STAY PET HOTEL to transport my dog to Dove Lewis Animal Hospital or the nearest available veterinary clinic for treatment of any sickness or symptoms that occur during daycare/boarding. I also agree to pay for all expenses for any veterinary services or on-site services that result from that occurrence. 3. I have read and understand the Rules and Regulations and agree to abide by them. I certify that I have read and understand this agreement and Release. I agree to accept the terms, conditions and statements of this agreement. Date: Owner s name: Signature of owner:

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