Owner/Guardian Information Daycare & Boarding Application Name: Date Address: City/State/Zip: E-mail Address: Home # Work # Cell # Place of Employment: Emergency Contact: (Required-not in the same residence) Name: Home # Work # Cell # Pet Information Name: Breed: Color: Age: Sex: Spayed/Neutered: Name: Breed: Color: Age: Sex: Spayed/Neutered: Name: Breed: Color: Age: Sex: Spayed/Neutered: Veterinarian Name and Clinic: City/State: Phone # How did you hear about Camp Barkalot? Google Dex Online Phonebook Drive-by-sign Yahoo Referrals Name Other Page 1 of 8
Feeding Instructions Does your pet have food allergies? Yes What brand of food do you feed your pet? How much food per meal? May we add wet dog food/dog treats to your dog s food if he/she isn t eating? Yes If boarding more than one pet, may they eat together? Yes Feeding is included with overnight boarding. However, if desired, you may bring your own food from home to keep your pet on their same diet. If bringing food from home we ask that you please pre-measure each feeding (we feed twice a day-breakfast and dinner) into Zip-Loc bags. General Information Can your dog(s) have treats in daycare? Yes Has your dog ever jumped a fence or barrier? Yes Has your dog ever bitten a human or other animal? Yes (If yes, please explain) Has your dog ever acted aggressive towards anyone who has taken his/her food away? Yes Does your dog have any disabilities? Yes (If yes, please explain) Please help us with any info to help your pet have the most fun while staying Page 2 of 8
PLEASE READ AND INITIAL EACH STATEMENT Before Camp Barkalot, LLC can accept any pet into our daycare and boarding facility they must pass a temperament evaluation test. There is no cost for this temperament evaluation and it is for the safety of the staff and other dogs. We cannot allow dogs with any aggressive behavior towards staff members and/or other dogs. Camp Barkalot can only accept dogs that have been fully vaccinated before joining our daycare and boarding facility. We recommend that your dog(s) be vaccinated every six months for Bordetella. Your dog(s) must also be spayed or neutered (if older than 7 months) to come. If Camp Barkalot makes an exception and your dog comes to our facility and it has not been spayed/neutered, Camp Barkalot is not responsible for any unplanned puppies as a result of your choice to still bring your pet. Camp Barkalot will provide a safe, clean and social atmosphere. We will permit only playful and nonaggressive dogs in our facility. Pets sometimes like us have a bad day and display bad behavior. In that case your pet may be separated from the rest of the other dogs for 15 minutes to calm down. If the behavior becomes consistent, your dog may be asked to leave until the problem is corrected. Camp Barkalot will do everything possible to prevent injuries that might occur, but there is always a risk involved in allowing your dog(s) to interact with other dogs (dog bites, scratches, cuts, etc.), even under constant supervision. In the event that your dog causes injury to another dog or person during their stay, you will assume full liability for the actions of your dog and agree to pay for any and all medical bills that might occur. By entering your dog(s) at Camp Barkalot you agree not to file any legal charges against Camp Barkalot or any of its representatives for any injury to your dog. You acknowledge that pet boarding can be stressful on your pet because of unfamiliar surroundings. This can result in illness, seizures, or destruction of surroundings. You or your emergency contact will be notified immediately. You are aware of this and will not hold Camp Barkalot responsible. Camp Barkalot provides blankets and bedding for your dog(s) while boarding. Please do not bring toys, blankets, or beds from home. We do encourage you to bring your own dog s food if you would like them to stay on the same diet. Camp Barkalot will do everything to keep your dog(s) safe and secure during their stay with a sanitized building and making sure all pets are up to date on all required vaccinations. But even a flu shot does not prevent the flu. We recommend that your pet be vaccinated up to date a week before their stay. By signing below, you have agreed to all terms described above. Owner Signature: Print Name: Date: Page 3 of 8
Owner Agreement I understand that I am solely responsible for any harm caused by my dog(s) while attending Camp Barkalot, LLC. I further understand and agree that in admitting my dog(s) to Camp Barkalot, Camp Barkalot representatives have relied on my representation that my dog(s) is/are good health and have not harmed or shown aggressive behavior towards any person or any other dog. I further understand and agree that Camp Barkalot, LLC and all of its representatives and volunteers, will not be held liable for any problems which develop, provided reasonable care and precautions are followed, I hereby release them of any liability of any kind whatsoever arising from any of my dog(s) attendance and participation at Camp Barkalot. I further understand and agree that any problems which develop with my dog(s) will be treated as deemed best by staff and volunteers of Camp Barkalot at their sole discretion, and that I assume full financial responsibility for any and all expenses involved. I certify that I have read and understand the policies of Camp Barkalot, LLC as set forth on the preceding pages and that I have read and understand the conditions, and statements of this agreement. Signature of owner/guardian: Date: Name of dog(s): Page 4 of 8
Emergency Medical Care YES, I want medical attention for my pet if a medical emergency arises. I give Camp Barkalot permission to seek medical attention and agree to be responsible for any payment and all medical bills for my pet. I release Camp Barkalot and its representatives from any responsibility for claims, damages, debts, or deaths arising from such medical care. Camp Barkalot will try to contact my veterinarian. If for some reason Camp Barkalot cannot contact my veterinarian or if medical attention is an emergency, I give Camp Barkalot permission to have my pet treated by another qualified veterinarian at their discretion. Signature Print Name Date NO, I do not want Camp Barkalot to seek medical attention for my pet should any medical emergency arise. I release Camp Barkalot from any claims, damages, debts, or deaths that are related to any lack of medical attention that I have declined for my pet. Signature Print Name Date Page 5 of 8
MEDICATION RELEASE I do not hold Camp Barkalot, LLC or any of its representatives responsible regarding the administering of medication, (of any kind) to my dog(s) while visiting Camp Barkalot. I understand the representatives of Camp Barkalot will do their very best to follow the prescribed dosages of medication in a timely manner, however, if there are any consequences associated with the medication or illness, Camp Barkalot will not be held responsible. Signature: Date: Dog(s) Receiving Medication Name: Breed: Medication Name: Side effects of medication: Condition being treated: Dosage: Special instructions for administering medication: Page 6 of 8
ABANDONED DOGS OR CATS pet may be left at Camp Barkalot after the scheduled pick up time without communication from you. If your pet is left at Camp Barkalot without any contact, instruction or notification regarding its pick up from you or your authorized representative, your pet will be deemed ABANDONED at 7 PM on the seventh (7 th ) day after the scheduled pick up date. If you abandon your pet at our facility, Camp Barkalot will become its legal owner and guardian. Camp Barkalot will, in its sole discretion, determine whether to rehome the dog or relinquish it to a shelter or a rescue of Camp Barkalot s choice. YOU FULLY UNDERSTAND AND AGREE THAT IF YOU ABANDON YOUR DOG AT CAMP BARKALOT, YOU MAY BE UNABLE TO RETRIEVE POSSESSION OF YOUR PET AND WILL HAVE NO RECOURSE AGAINST CAMP BARKALOT. Signature: Date: Page 7 of 8
BLOAT AGREEMENT FOR CAMP BARKALOT Any dog is susceptible to Bloat. At Camp Barkalot there is a lot of activity with daycare and boarding when dogs are playing. Extra large breeds of dogs with deep chests are more susceptible to a medical condition called Bloat. Gastric dilation and volvulus syndrome (GVD), more commonly referred to as gastric torsion or bloat, is a disease in dogs in which the stomach dilates and then rotates, or twists, around its short axis. A number of emergency conditions may result as a consequence of this gastric rotation. Bloat develops suddenly, usually in a healthy, active dog. The dog may have just eaten a large meal, exercised vigorously before or after eating, or drank a large amount of water immediately after eating. They may also gulp air if they drink too much water too quickly. Bloat can occur in any dog at any age, but typically occurs in middle age to older dogs. Large breed dogs with deep chests are anatomically predisposed. These breeds include the Great Dane, German Shepherd, St. Bernard, Labrador Retriever, Irish Wolfhound, Great Pyrenees, Boxer, Weimaraner, Old English Sheepdog, Irish Setter, Collie, Bloodhound, and Standard Poodle. Chinese Shar-Pei and Basset Hounds have the highest incidence among midsize dogs. Small dogs are rarely affected, with the exception of Dachshunds, who are also deep chested. At Camp Barkalot, where there is doggy daycare and boarding, there is a lot of activity for my dog. Camp Barkalot is not responsible if my dog has symptoms or develops symptoms of bloat. I understand there are risks involved with letting my dog play and exercise at the facility. I am totally responsible for any vet bills or surgery required for this condition. Owners Signature Pet s Name Date Page 8 of 8