Pet Owner Information: Name Address City State Zip Work phone Home phone Cell Phone Email address How did you hear about us? Emergency Contact Information Name Phone Number Please list any additional persons who are permitted to pick up your dog(s) Pet Information: Pet # 1 Pet # 2
Release of Liability, Terms and Disclaimer: The staff at Canine Clips Grooming Boarding is here to serve you and your pet(s) to the best of our ability. We want to make you time away worry free, and you pets stay pleasant and stress free. If you have any questions regarding our policies or practices, please talk with Carla Maynor (owner). If your pet is hurt, injured or becomes ill, Canine Clips, has permission to call or take your pet to the closest available Veterinarian, administer medication (as directed by Veterinarian) or provide other advisable attention, within our discretion and judgement. All attempts will be made to contact the owner, in case emergency treatment is needed. We will not be held responsible for injuries, or damages caused by your pet, to other pets, persons, property, or itself, during grooming or boarding. All expenses incurred will be paid promptly, by owner. Canine Clips Grooming and Boarding will not be responsible for conditions that can be unavoidable in boarding environments such as, but not limited to, weight loss, hot spots, Canine Cough, bloat, diarrhea, Canine Influenza, Parvo, parasites, or seizures. We can also not be held responsible for the death of your pet, due to illness, pre-existing conditions, sudden death, old age, etc. or injuries/death resulting from natural disasters (fire, storm, hurricane, etc.) In the event of your pet s demise, the remains will be held at the local Vet s office until owner return, unless other arrangements have been made. Any claims by owner, regarding injury, or negligence resulting in the need for medical treatment, must be reported to Canine Clips Grooming and Boarding within 48 hours. In the event of a claim, the Pet Owner authorizes Canine Clips Grooming and Boarding to personally consult with any attending Veterinarians, to release any and all medical information, discuss treatment, etc. prior to possible settlement of any claim. In signing this agreement, you are granting that Authorization. We reserve the right to charge additions fees for services over and above the norm, covered by our standard rates. These include, but are not limited to flea or tick removal, matted dogs, behavior problems, extra care for ill or geriatric pets, giving medicine or other special needs. We also reserve the right to refuse service to any pets that we feel may pose a threat to our staff, to themselves or other pets left on our care. This includes, but is not limited to, aggression, medical issues, personality or parasite problems. Any pet not picked up within five (5) days of stated date of owner return, will be considered abandoned. Canine Clips Grooming and Boarding, has the right to then place the abandoned pet in a suitable home or surrender it to Animal control. We will pursue collection, from the owner, for all fees pertaining to boarding, grooming, placement, including legal fee s incurred. In signing below, I acknowledge that I have read and agree to the above Terms and Policies. I also certify that my pet(s) appear to be free of contagious diseases, including internal and external parasites. I understand that if parasites are found, they will be treated, and my account charged accordingly. I also certify that my pet has a current Rabies vaccination, as required by law. Signature: Date:
If you have any problems regarding your Pets Grooming or Boarding, Please call and talk with us! Additional Pet Information: (for more than two pets) Pet # 3 Pet # 4 Pet # 5