New Client Information
New Client Information
Owner Name: Last______First______
Spouse ______
Address: ______
City, State, Zip Code: ______
Email Address: ______
Phone -home:( )___ - ______cell1:( )____ - ______
work: ( )____ - ______cell2: ( )____-______
Emergency Contact: ______
Phone: ( )____-______Alt. Phone: ( ) ____-______
Vet Hospital ______
Pet Name ______Spay/Neutered______
Color______Breed______Birthdate __/__/__
Pet Name ______Spay/Neutered______
Color______Breed______Birthdate __/__/__
Pet Name ______Spay/Neutered______
Color______Breed______Birthdate __/__/__
Pet Name ______Spay/Neutered______
Color______Breed______Birthdate __/__/__
Pet Name ______Spay/Neutered______
Color______Breed______Birthdate __/__/__
Animal House Pet History Form
Please print and fill out this page, one per dog.
Dog’s Name ______
PLEASE CIRCLE THE ANSWER TO THE FOLLOWING QUESTIONS TO HELP OUR STAFF BETTER CARE FOR YOUR PET:
1. HAS YOUR PET BEEN BOARDED BEFORE? YES NO
2. HAVE YOU OR YOUR PET HAD A BAD EXPERIENCE BOARDING? YES NO
IF YES PLEASE EXPLAIN WHY: ______
______
3. IS YOUR PET AGGRESSIVE TOWARD PEOPLE? YES NO
4. IS YOUR PET AGGRESSIVE TOWARD OTHER ANIMALS? YES NO
5. HAS YOUR PET EVER BITTEN ANYONE? YES NO
6. IS YOUR PET ALLERGIC TO ANYTHING? YES NO
IF YES PLEASE LIST ALL ALLERGIES: ______
______
7. IS YOUR PET PRONE TO ESCAPE FROM FENCING? YES NO
8. DOES YOUR PET JUMP OR CLIMB FENCES? YES NO
9. DOES YOUR PET LIFT FENCE LATCHES? YES NO
10. IS YOUR PET HAVING A NORMAL STOOL AT THIS TIME? YES NO
11. IS YOUR PET CHEWING ON HIMSELF OR HAVING ANY SORE SPOTS? YES NO
12. IS YOUR PET A FINICKY EATER? YES NO
13. IS YOUR PET ON A SPECIAL DIET? YES NO
14. SHOULD WE BE CONCERNED IF YOUR PET DOES NOT EAT WELL? YES NO
15. HAS YOUR PET HAD AN INJURY, SICKNESS, OR MEDICAL
EMERGENCY WITHIN THE LAST 30 DAYS? YES NO
IF YES, PLEASE EXPLAIN: ______
______
16. IS YOUR PET AFRAID OF THUNDER STORMS AND LIGHTNING? YES NO
17. IS YOUR FEMALE DOG DUE TO COME INTO HEAT SOON? YES NO
18. IS YOUR PET TAKING ANY MEDICATIONS? YES NO
PLEASE CIRCLE ANY OF THE FOLLING THAT YOUR PET IS HAVING OR HAS HAD IN THE PAST:
SEIZURES DIABETIESHEAT EXHAUSTIONCOLLAPSED TRACHEA
KENNEL COUGHSTRESS COLITIS (DIARRHEA)BLOAT
URINARY TRACT INFECTION HIP DYSPLASIABLIND
ARTHRITISDEAF HEAT CYCLE
ABNORMAL BREATHINGINTESTINAL WORMS FELINE LEUKEMIA/HIV
OTHER: ______
______
HOW DID YOU TREAT THE ILLNESS: ______
______
DATE: ______PET OWNER SIGNATURE:______
Animal House Cat History Form
Please print and fill out this page, one per cat.
Cat’s Name ______
PLEASE CIRCLE THE ANSWER TO THE FOLLOWING QUESTIONS TO HELP OUR STAFF BETTER CARE FOR YOUR PET:
1. HAS YOUR CAT BEEN BOARDED BEFORE? YES NO
2. HAVE YOU OR YOUR CAT HAD A BAD EXPERIENCE BOARDING? YES NO
IF YES PLEASE EXPLAIN WHY: ______
______
3. IS YOUR CAT AGGRESSIVE TOWARD PEOPLE? YES NO
4. HAS YOUR CAT EVER BITTEN ANYONE? YES NO
5. IS YOUR CAT ALLERGIC TO ANYTHING? YES NO
IF YES PLEASE LIST ALL ALLERGIES: ______
______
6. IS YOUR CAT HAVING A NORMAL STOOL AT THIS TIME? YES NO
7. IS YOUR CAT CHEWING ON HIMSELF OR HAVING ANY SORE SPOTS? YES NO
8. IS YOUR CAT A FINICKY EATER? YES NO
9. IS YOUR CAT ON A SPECIAL DIET? YES NO
10. SHOULD WE BE CONCERNED IF YOUR CAT DOES NOT EAT WELL? YES NO
11. HAS YOUR CAT HAD AN INJURY, SICKNESS, OR MEDICAL
EMERGENCY WITHIN THE LAST 30 DAYS? YES NO
IF YES, PLEASE EXPLAIN: ______
______
12. IS YOUR CAT AFRAID OF THUNDER STORMS AND LIGHTNING? YES NO
13. IS YOUR CAT TAKING ANY MEDICATIONS? YES NO
PLEASE CIRCLE ANY OF THE FOLLING THAT YOUR PET IS HAVING OR HAS HAD IN THE PAST:
SEIZURES DIABETIESHEAT EXHAUSTIONCOLLAPSED TRACHEA
KENNEL COUGHSTRESS COLITIS (DIARRHEA)BLOAT
URINARY TRACT INFECTION HIP DYSPLASIABLIND
ARTHRITISDEAF HEAT CYCLE
ABNORMAL BREATHINGINTESTINAL WORMS FELINE LEUKEMIA/HIV
OTHER: ______
______
HOW DID YOU TREAT THE ILLNESS: ______
______
DATE: ______PET OWNER SIGNATURE:______
Animal House
665 Bell Fork Road
Jacksonville, NC 28540
(910) 353-2684
All pets shall be treated for parasites, such as fleas, if seen,
upon entrance to the Animal House at owner’s expense.
This contract is between Animal House and the pet’s owner,
whose signature appears below
Initial:
______ 1. Owner agrees to pay the rate for boarding in effect on the date of pick up.
______2.On the day of pick up the pet must be picked up by 1:00 p.m. to avoid another days charge.
______ 3. It is MANDATORY, that all pets MUST be vaccinated for animal diseases such as Rabies, Distemper, Parvovirus (DHPP), and Bordetella, within the time period a veterinarian recommended prior to the pet entering Animal House.
______4. Owner agrees to pay all costs and charges for special services requested and all veterinarian costs for pet during its stay.
______5. Owner agrees that the pet shall not leave Animal House until all charges are paid.
______6. By signing this contract and leaving pet with the kennel, owner guarantees the accuracy of all information given.
______ 7.Animal House shall exercise reasonable care for the pet. In the event Animal House is liable for injury or death it is expressly agreed by the owner and the kennel that Pet owner’s compensation for said pet shall not exceed the sum of $200.00 per animal boarded.
______ 8.Owner agrees to be responsible for any and all acts of behavior of the pet, during its stay at Animal House, any damages by pet will be paid by pet Owner
______ 9. Owner specifically represents that he or she is the sole owner of the pet.
______ 10.Animal House shall have, and is granted, a lien on said pet for any and all charges resulting from boarding pet.
______ 11. The Kennel shall have and is granted a lien on said pet for any and all charges resulting from boarding pet. Owner agrees that in the event the boarding charges are not paid when due in accordance with the contract, the Kennel may exercise it’s legal right to hold pet for 10 days while awaiting payment, after which pet is placed for public sale for sufficient money to cover the charges incurred for said pet’s stay. If pet is sold for an insufficient amount to cover charges incurred, the kennel will seek legal action against the pet Owner
______ 12. If pet becomes ill during stay and needs professional attention, Animal House may engage the services of a Veterinarian at Owner’s expense along with a $20.00 transportation fee.
______13.”Canine Cough” is a highly contagious AIRBORNE upper respiratory infection. It is contagious prior to showing symptoms. Canine Cough is uncontrollable and is commonly spread at places where dogs congregate such as dog parks etc. However your pet can acquire this illness without contact with other dogs.
______14. All pets boarding must be healthy, free of contagious illness, and vaccinated appropriately.
______ 15. Animal House is not responsible for your pet acquiring diseases while staying at Animal House, or costs associated with treatment of such illness (including intestinal Parasites or canine cough).
______16. We provide bedding, you may bring your own but WE ARE NOT RESPONSIBLE FOR DAMAGED OR LOST ARTICLES.
The Kennel guarantees the best care for any pet that it could possibly give. The Owners of this Kennel have pets and will treat your pet just as they would treat their own. We appreciate your business and hope to serve you and your pet now and in the future.
Owner Signature: ______
Kennel Representative Signature: ______
Animal House
665 Bell Fork Road
Jacksonville, NC 28540
(910) 353-2684
DAYCARE, OVERNIGHT CARE, POOL, WET N WILD, AND CABANA LODGING
IN CONSIDERATION OF MY DOG(S) PARTICIPATING IN ANY WAY IN THE DAYCARE AND OVERNIGHT CARE, POOL AND CABANA PROGRAM WITH ANIMAL HOUSE, I ACKNOWLEDGE AND AGREE THAT:
Initial:
______1. The risk of injury to me and/or my dog(s) is significant, including the risk of being bitten, scratched, and punctured are not uncommon while dogs play with their teeth and paws. While the supervision of the staff of Animal House will minimize the risk, the possibility of serious injury does exist during group playtimes with other dogs.
______2.I knowingly and freely assume all such risks for myself and my dog(s) in the care of Animal House.
______3.In the event that my pet should become ill or injured while in the care of Animal House I hereby authorize Animal House to seek Veterinarian care for my pet(s) as they deem necessary. I grant permission for Animal House to use the Veterinary Hospital of their choice. I understand that after hours may require use of the emergency Veterinarian Hospital.
______4.In the event that my pet(s) should need veterinary care I understand and agree to assume all Veterinary costs plus a $20.00 transport fee.
_____5.I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless Animal House, the owners, employees, volunteers and anyone else associated with Animal House from any and all claims as a result of illness or injury (including intestinal Parasites and canine cough) to myself or my pet(s) during participation in the Daycare, Overnight Boarding, and all additional activities.
I have read this authorization of veterinary care, release of liability and assumption of risk agreement, fully understand its terms and sign it freely and voluntarily. I authorize Animal House to seek veterinarian care for my pet(s) and obtain any medical records for my pet(s); current or past.
Owner’s Name: ______Pet 1 ______
Owner’s Signature: ______Pet 2 ______
Pet 3______
Pet 4______
Pet 5______
Rules for Day Campers
Thank you for joining the Day Camp Program! We have designed our day camp program to maximize your pet’s socialization with People and other pets.
Initial:
_____When not to bring your pet:
If they are:
- Having diarrhea or vomiting
- Nasal discharge or cough
- Being treated for internal parasites
- Diagnosed with a contagious condition
_____When they may be sent home:
If they are:
- Having diarrhea or vomiting
- Nasal discharge or cough
- Observed to have parasites (fleas, ticks, or worms)
- Aggressive towards the daycare provider
- Generally not acting themselves
_____When they may not play with others:
If they are:
- Aggressive towards playmates
In heat cycle- Not neutered by 8 months of age
- Having a grouchy day
- Showing any signs of illness or showing any signs or
parasites (worms, fleas, ticks) - If injured; or have any sutures
_____What to bring to day camp:
- Lunch and snacks, we do not feed breakfast or dinner
- We provide bedding, you may bring your own but
WE ARE NOT RESPONSIBLE FOR DAMAGED
OR LOST ARTICLES.
**We offer refresher baths and full service grooming so your pet will be fresh for pick up**
*Payment Policy: Payment is expected weekly by cash, check, or credit card.*
Please remember doggie day camp is lots of fun. It may take a few days for your pet to warm up to their playgroup, and for you to notice the benefits of doggie day camp. Just like children’s daycare, accidents may happen and airborne illnesses such as colds may get passed around. Without notice personalities may clash even with those who have always played well together. Our day camp staff limits playgroup size, the staff matches personalities, and monitor activities closely to avoid accidents or injuries. We are not responsible for cost associated with injuries, illness (including intestinal parasites), or accidents.
We know your pet will love doggie day camp. Thank You for trusting Animal House
to care for your pet!
I understand the rules of doggie day camp ______.
(Customer Signature)
Thank You Animal House