Online client intake form – Heavenly Hound Hotel

Name *

First

Last

Phone Number *

Email *

Address *

City, State, Zip *

Emergency Contact Name *

Emergency Contact Phone *

Name of Veterinary / Animal Hospital *

Please include phone number of the Animal Hospital / Veterinarian.

Pet's Name *

Pet Type *

Dog
Cat
Other

Breed *

Example: Labrador Retriever, Boxer, Yorkie, etc

Color *

Pet's Age / Date of Birth *

Sex *

Female
Male

Neutered / Spayed *

Yes
No

Pet's Weight *

Microchip #

Food: *

Please include: the amount of food in cups & how many times per day.

Medications:

Please list any / all medications your pet is taking, along with dosage instructions.

Allergies:

List any allergies your pet may have.

Disabilities:

List any disabilities your pet may have.

Restrictions:

No Jumping
No Running
No Hard Play

Comment or Message

CONSENT TO TREAT *

By checking this box you give Heavenly Hound Hotel consent to treat your pet.

We want to provide the best possible care for your pet while being boarded here at Heavenly Hound Hotel. With that in mind however, sometimes emergencies do occur. In the event that your pet should become ill, we will contact you.

If we are unable to reach you, we will provide emergency care at Coastal Veterinary or at Pet’s ER in Salisbury, MD. You will be financially responsible for any medical or surgical treatment deemed necessary for the well being of your pet until you can be reached.

Policies and Release of Liability *

By checking this box you have Read, Understood, & Accept the "Release of Liability".

1. I (Owner) represent that I am the legal owner of the above named dog/cat(s) and I assume all risks, dangers, and responsibility for injuries to the named dog/cat(s). Owner understands and agrees that Owner is solely responsible for any harm while Owner’s dog/cat(s) is/are attending Daycare / Boarding / Grooming.

2. DOG’S HEALTH: Owner further understands and agrees that Owner’s dog(s) are healthy and will at all times while attending Heavenly Hound Hotel have current vaccinations for Rabies, Distemper (DA2PP), and Bordetella. Owner will not enroll any dog that has any condition that could potentially jeopardize the health of other dogs or people and has not had any potentially communicable condition within 30 days prior to enrollment. Owner further understands that even if Owner(s) dog has a current vaccination for Bordetella (kennel cough) there is a chance that the Owner’s dog can contract any upper respiratory tract infection, such as kennel cough. Owner agrees that Owner will not hold Heavenly Hound Hotel responsible if Owner’s dog(s) contract(s) any upper respiratory tract infection (I.e. kennel cough, or other URI), or any other dog-dog transmitted ailments.

3. CAT’S HEALTH: Owner further understands and agrees that Owner’s cat(s) are healthy and will at all times while attending Heavenly Hound Hotel have current vaccinations for Rabies and Distemper (FVRCP). Owner will not enroll any cat that has any condition that could potentially jeopardize the health of other cats or people and has not had any potentially communicable condition within 30 days prior to enrollment. Owner further understands that even if Owner(s) cat(s) has a current vaccination for Distemper (FVRCP), there is a chance that the Owner’s cat can contract any upper respiratory tract infection. Owner agrees that Owner will not hold Heavenly Hound Hotel responsible if Owner’s cat(s) contract(s) any upper respiratory tract infection, or any other cat-cat transmitted ailments.

4. RELEASE OF LIABILITY: Owner understands and agrees that during normal dog/cat play, Owner’s dog/cat may sustain injuries. Dog/cat play is monitored by Heavenly Hound Hotel staff to best avoid injury, but scratches, punctures, torn ligaments, and other injuries may occur despite the best supervision. Owner further understands and agrees that Heavenly Hound Hotel nor any of its staff, will be liable for any illness, injury, death, and/or escape of Owner’s dog/cat(s) provided that reasonable care and precautions are followed. Owner hereby releases Heavenly Hound Hotel staff of any liability of any kind whatsoever arising from or as a result of Owner’s dog/cat(s) attending Heavenly Hound Hotel.

5. WEAKENED IMMUNE SYSTEM: Owner understands special-needs dogs/cats, young puppies/kittens, and senior dogs/cats naturally have a higher risk of injury, stress-related illnesses, weakened immune system, or exacerbation of any pre-existing condition. As such, by using our facility for daycare, boarding, or grooming, the Owner is waiving any claim for injury or illness experienced by the Owner's dog/cat while in our care.

6. ELDERLY DOGS/CATS: Owners of elderly dogs/cats (approaching the end of life) need to know if in the event Owner’s dog/cat passes on while in our care, our policy is to transport Owner’s dog/cat to Coastal Veterinary, LLC. Owner’s dog/cat will be held until Owner can be reached by Heavenly Hound Hotel staff for further instructions.

7. I understand that Coastal Veterinary, LLC is a separate entity and does not have any financial affiliation with Heavenly Hound Hotel.

8. RIGHT OF REFUSAL: Heavenly Hound Hotel reserves the right to refuse admittance to any dog/cat or dismiss any dog/cat that does not meet or maintain the health, temperament or other daycare/boarding/grooming standards. The determination shall be made at the sole discretion of Heavenly Hound Hotel staff.

9. FULL FORCE AND EFFECT: Owner further understands and expressly agrees that each and every of the foregoing provisions contained in paragraphs 1-8 above shall be in force and effect and shall apply to each and every occasion on which Owner’s dog/cat(s) stays with Heavenly Hound Hotel for daycare, boarding, or grooming, as the case may be. This Agreement shall remain in full force and effect as between the parties until and unless otherwise canceled or superseded by a writing signed by the parties.

Owner hereby certifies that Owner has read and understands this Waiver and Release of Liability and the regulations set forth above. By checking the box above, Owner agrees to be bound by its terms and conditions.