Stay and Play Pet Resort Admission Form

Owner Name: (Last)

Owner Name: (First)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone

Email

example@example.com

Emergency Contact Name

Emergency Contact Phone

Pet Name

Pet Breed

Pet Age

Sex:

MaleFemale

Intact?

YesNo

Colour

Medication 1:

Medication 1 Dose:

1X Daily2X Daily3X Daily

Medication 2:

Medication 2 Dose:

1X Daily2X Daily3X Daily

Last treatment

Allergies

SkinFood

Medicine Storage:

RefrigerateRoom Temperature

Your Veterinarian

Veterinarian's Phone

Dog Food:

OwnerSPPR

Cups per Feeding:

Feeding frequency:

Once per dayTwice per dayThree times per day

Owner Treats:

YesNo

Amount of Treats:

Treat feeding frequency:

Once per dayTwice per dayThree times per day

Owner Provided:

ToysBedBlanketsOther

Is your pet friendly with other dogs:

YesNo

Is your pet friendly with humans:

YesNo

Has your pet bit a person/animal:

YesNo

Is your pet playful with other dogs:

YesNo

Is your pet comfortable with someone taking something from them:

YesNo

Is your pet afraid of storms:

YesNo

Does your pet climb fences:

YesNo

Does your pet chew toys, bedding or furniture:

YesNo

Whenever a problem is discovered in a boarding pet that requires medical treatment, SPPR will attempt to contact Owner or their emergency contact person before obtaining examination by and/or treatment from a veterinarian. SPPR will transport pet free of charge to veterinary clinic of choice listed by Owner if said clinic is within 15 miles of SPPR or to Baker Animal Clinic. Baker Animal Clinic would assume medical care of the pet if veterinary clinic selected by Owner is closed or unable to accept pet during regular business hours or emergency hours. All medical care performed on pet by Owner's selected veterinary clinic or by medical staff of Baker Animal Clinic shall be at Owner's expense.

Select clinic to contact first for medical care:

Veterinary Clinic of Owner named aboveBaker Animal Clinic

Owner Signature

Date

Photo Release Form

I hereby grant permission to Stay and Play Pet Resort (SPPR) and/or Baker Animal Clinic PLLC (BAC) to use gratis photograph(s), image(s) and call (given) name of my pet, and only these, on any printed or electronic social media site(s) including websites (e.g., www.stayplaypetresort.com; www.bakeranimal.com) and/or Facebook sites controlled by SPPR and BAC. Further, SPPR and/or BAC have my permission to edit photograph(s)/image(s of my pet(s) at their discretion and that SPPR and/or BAC may decide at their discretion when to use, not use or discontinue use of any photographs(s)/image(s) of my pet(s) on such media sites. I understand that photograph(s)/image(s of my pet(s) may be available for copy or download without restriction from electronic social media sites available for public viewing.

Signature by:

AgentOwner

Your Name

Dog Name(s)

Signature

Waiver and Liability Release

I accept terms and conditions of Waiver and Liability Release as presented in such document on web site of SPPR (www.stayplaypetresort.com) and available for review during check-in of pet at SPPR reception.

I am the Owner or agent of Owner of pet (pets) that is (are) boarding and under care of Stay & Play Pet Resort LLC (SPPR) and/or Baker Animal Clinic LLC (BAC), and as consideration for the right to participate in services provided by SPPR and/or BAC, I hereby knowingly and voluntarily enter into this waiver and release of liability and therefore hereby waive any and all rights, claims or causes of litigation or any action whatsoever arising out of my participation in any activity or services, professional or otherwise, provided by SPPR and BAC and do now hereby release and forever discharge SPPR and BAC, their affiliates, creditors, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical injury including but not limited to medical emergency, illness, infectious or non-infectious illness, damages, death suffered by my pet(s) and any economical or emotional loss that Owner may suffer as a direct result of their pet(s) participation in activities and services of SPPR or BAC, including transport of pet(s) to and from SPPR and BAC. Furthermore, I agree to be financially responsible for any and all costs incurred as result of any veterinary medical services required by my pet(s) for whatever cause arising during my pet(s) care by SPPR and /or BAC.

Signature

Signature:

OwnerAuthorized Agent

Your Name

Name:

OwnerAuthorized Agent

Date

Stay and Play Pet Resort Admission Form

Thank you for choosing Stay and Play Pet Resort