1. Owner’s Name: _____________________

2. Full Address: _________________________________________________________

              _________________________________________________________

4.  Back-Up Contact Person  ___________________   #  (         )________

5.  Date of Drop-Off: ________________________________________

6. Date and Estimated Time of Pick-Up: ________________________

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 so, 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?          Yes________________ No________________

14. Would you like your pet to have a bath/ nail trim prior to departure?           (Typical bathing charges will apply and baths can only be done on matt-free hair.)                                                           Yes______ No_______

 (In order to protect the integrity of the establishment, should we find fleas on your dog, your dog will be given a flea bath and you will be charged accordingly.)

Please list items brought with dog: 

Toys_______________________________________________

          Bedding_____________________________________________

          Food______________________________________________

         Amount fed per day: ________________________________

 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)_______________  ______________________