Customer

Agreement
This form is required of all clients of K-9 to 5, and it is also used as our application.  Please complete all fields.  We will be in touch with you upon receipt of this form.
VACCINATIONS: Customers must provide a complete vaccination history of the dog and ensure his physical well-being through preventative veterinary care. In the event of a medical emergency, K-9 to 5 will seek veterinary treatment for which the customer will be financially responsible.

K-9 to 5 shall exercise all due and exceptional care to prevent injury, illness and loss of a dog in our care. In the event of injury, illness or loss, K-9 to 5, its owners and its employees shall not be held personally liable.

K-9 to 5 has full responsibility for the customer’s dog at all times while he is on the premises.

LIABILITY ASSURANCE: I guarantee that I am the owner of the dog described below. I agree to pay the costs of property damage and personal injury caused by my dog’s physical or behavioral aggression, while properly confined and supervised by K-9 to 5 staff. I assure K-9 to 5 that my dog is tolerant of adults, children and dogs of both genders. My dog is accustomed to being handled and he is crate trained. If my dog is left with K-9 to 5 for more than 48 hours after closing on the day he was dropped off, he will be deemed to be abandoned and decisions about his whereabouts thereafter will be made by K-9 to 5.

CONSENT TO TREATMENT: I understand that in the case of a medical emergency, every effort will be made to contact me prior to treatment. If I cannot be reached and the situation requires immediate emergency attention as determined by K-9 to 5, I hereby authorize K-9 to 5 to obtain emergency treatment for my dog as deemed necessary by K-9 to 5. I give permission for any and all medical and other information to be given to others if deemed by K-9 to 5 to be necessary for the health and well-being of my dog. K-9 to 5 and its staff will not be held liable for procedures performed pursuant to this consent. Photocopies of this form may serve the purpose of the original. I agree to be financially responsible for all costs of veterinary and other emergency care pursuant to this consent.

MEDICATIONS, PRESCRIPTION: Prescribed medication must be in its original container with veterinarian or pharmacy label showing the number, dog’s name, owner’s name, date filled, veterinarian name, name of medication and directions for use. I authorize K-9 to 5 to administer prescribed medications to my dog.

About the customer/dog owner:

Name
Street Address
City
State
ZipCode
Day Phone
Eve Phone
E-mail

Emergency contact, if you cannot be reached:

Name
Day Phone
Eve Phone
E-mail

Dog's name: 


Breed:

Gender:

Reproductive capability:

Microchip number:

Date of birth, or approximate age:

Contact information for the dog's regular veterinarian:

Veterinarian Name
Hospital/Clinic
Street Address
City
State
ZipCode
Phone

Indicate all training your dog has had:

Basic manners/beginner obedience
 Intermediate/advanced obedience
 Agility
 Protection
 Field/working/tracking/hunting

Other training:

List past day care or boarding facilities of this dog. 

Proprietor
Facility
Street Address
City
State
ZipCode
Phone
E-mail
Proprietor
Facility
Street Address
City
State
ZipCode
Phone

Things we should know about your dog:

Please indicate that you have read and understand the Customer Agreement at the top of this form,
and that you agree with its content.  This agreement will serve as your signature.

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