You may copy and paste this form onto a blank word document or print this page if you prefer to have your form filled out prior to arrival.
CUSTOMER CHECK IN FORM
1. Owner’s Name: _________________________________________
2. Address: _______________________________________________
3. Phone # You Can Be Reached At ( ) ____________________
4. Back-Up Contact Person: _________________________________ # ( )______________
5. Date of Drop-Off: ______/_____/________
6. Date of Pick-up:______/________/________ TIMEof Pick-up:______________(This is very helpful information for us!)
7. Pet’s Name: _____________________________
8. Breed or Description: ___________________
9. Pet’s Age: _________________________
10. Health Conditions We Should Be Aware Of: _____________________
11. Has Your Pet Been Spayed or Neutered? Yes______ No________
12. Does Your Pet Require Medication? Yes_______ No________
If "Yes", how is normally administered? __________________________________________________________
13. In the case your pet should require medical care, if your vet is not available, do we have your permission to take your pet to another veterinarian? Please initial* Yes________________ No________________
14. Would you like your pet to have any grooming? Yes _____________ No ______________
(Typical shop charges will apply and baths can only be done on matt-free hair.) Bath (includes nail trim) ______________ Nail trim only ______________
Full Groom ______________________________
* If you would like a full groom (hair trimming) please specify on form and discuss with groomer. No guarantees last minute groom requests can be done.__________________________________________________________________________
(In order to protect the integrity of the establishment, should we find fleas on your dog, your dog will be given a flea bath or a Capstar pill and you will be charged accordingly, whether you agree to grooming or not.)
Please list items brought with dog:
Amount fed per day (if not specified elsewhere): ___________cups__________x a day
Add-On Services: _________________________for ____________days/times
Please sign liability release on page 2.
Boarding Release Agreement
1. I agree to release Ritzy Rascals Pet Resort and the entire staff from any and all liability that results in loss, damage, injury, and sickness to my dog while under the care of Ritzy Rascals Pet Resort.
2. I agree to assume full responsibility and financial reimbursement to Ritzy Rascals Pet Resort and entire staff for all damages, losses, and injuries that are caused by my dog while under the care of Ritzy Rascals Pet Resort.
3. I verify that my dog is healthy, has the required vaccinations (DHPP, Bordetella and Rabies) , is free of sickness or disease and has not harmed or shown aggression toward people or other dogs. I agree to arrange to have my dog returned home or boarded at a Vet Clinic if contagious illness is suspected.
4. In the event of an emergency, I agree to allow the staff at Ritzy Rascals Pet Resort to transport my dog to a Vet Clinic of our choice for treatment of any sickness or symptoms that occur during its stay. I also agree to pay for all expenses for any veterinary services that result from that occurrence.
5. Under Kansas law any dog left for a period of over 10 days without notification may be considered abandoned and may legally be transported to the custody of an animal shelter.
--I have read and understand this boarding agreement and release from liability. I agree to accept all the terms, conditions, and statements of this agreement.
Signature of Owner________________________ Date _________
Printed Name ______________________
Pet’s Name(s)_______________ ______________________