Owner Information

Name(s) __________________________________________________________

Address _______________________________________ City _______________

State ______ Zip Code _______  Home Phone ______________ Cell Phone__________

Place of Employment & Title ___________________________________________

Work Phone ______________________


Emergency Contact (other than self)

Name ____________________________ Relationship _____________________

Home Phone ___________________ Cell Phone _____________________


Pet Information  

Name ___________________________ Breed _____________________ Sex ________

Neutered/Spay _______Birthday ___________ Weight ___________


Veterinarian

Facility Name _______________________________

Phone _____________ Vet’s Name ________________


Pet Personality Profile:  General Information

How did you hear about Pet Palace Resort & Spa? ______________________________

Are  their any kinds of people your dog automatically fears or dislikes? _____________________________________

What commands does your dog know? ___________________________________________________________
Health & Grooming

What is the flea/tick treatment that you use? _____________________________________________________

Does your dog have any sensitive areas on his/her body? _____________________________________________________

Where are your dog’s favorite petting spots? _____________________________________________________

Does your dog suffer from any of the following:  
    

• Flea Allergies/Contact Allergies/Food Allergies___________________________

• Heart murmur or any other circulatory conditions__________________________

• Arthritis, hip/elbow dysplasia, or any other bone related conditions____________

• Severe separation anxiety________________________________

• Constipation/loose stool, corpophagy(poop eating), gas_____________________

• Dry skin, cracked foot pad’s, flaky/cracking nails__________________________

• Eye problems: cataracts, growths, dryness, cherry eye, repeat infections_________

• Repeat bladder or urinary tract infections____________________________

• Other_________________________________________________

Behavior

Has your dog ever bitten someone? __________ What were the circumstances?

________________________________________________________________________

Has your dog ever climbed or jumped over a fence? _____ How high was it __________

Does your dog have any problems in the following areas?  

Mouthiness, Housetraining, Barking, Digging, Ignoring Commands, Scared of certain noise       

_____________________________________________________________________________________ 

Health & Temperament Agreement


I understand that I am solely responsible for any harm caused by my dog(s) while my dog(s) are attending Pet Palace Resort & Spa and agree to pay any medical expenses for any dog(s) that is (are) harmed by the fault of my dog(s).

I further understand and agree that in admitting my dogs(s), Pet Palace Resort & Spa has relied on my representation that my dog(s) is/are in good health and have not harmed or shown aggression or threatening behavior towards any person or any other dog.

I further understand and agree that Pet Palace Resort & Spa, their staff and volunteers, will not be liable for any problems that develop provided reasonable care and precautions are followed, and I hereby release them of any liability of any arising from my dog(s) attendance and participation at Pet Palace Resort & Spa.

I further understand and agree that any problems that develop with my dog(s) will be treated as deemed best by staff and volunteers of Pet Palace Resort & Spa, in their  discretion, and that I assume full financial responsibility for any and all expenses involved.

I certify that I have read and understand the rules and regulations set forth on the preceding page and that I have read and understand this arrangement. I agree to abide by the rules and regulations and accept all the terms, conditions and statements of this agreement.  

Signature of owner: ______________________________________________________

Date: _________________________________________