New Family Please fill out the form completely & click submit. Please fax, email or deliver in person a copy of your dog(s) vaccination record(s). We will verify that the form is complete. Once completed, you can schedule your dog(s) free "get to know us day" - Evaluation Day. Step 1 of 6 16% Client InformationTell us about you!Owner's Name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Cell Phone*Spouse/Partner Name First Last Cell PhoneEmergency Contact Name*Cell Phone*How did you hear about us?*Please Choose OneReferred by a FriendTreasure Hunt AdWeb SearchI don't recallFriend's Name Who Referred You* First Last Dog Information Dog's First Name Sex Actions Edit Delete There are no Dogs. Add Dog Maximum number of dogs reached. HIPAA - Authorization for Use, Disclosure of Health information, and Medical TreatmentShould your dog require medical treatment while in doggie daycare or while boarding with us, Four Paws Playground will contact your dog’s veterinarian to request a copy of your dog’s vaccinations, medical history, and to seek medical treatment for your dog if necessary. Your vet requires this written authorization from you, the dog’s owner or guardian, before your vet can release this information or treat your dog while in our care. Dog(s) Information Name Date Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Consent* I agree to the HIPAA Authorization Policy Contract and Pet Owner’s Waiver of RightsThis is a contract between Four Paws Playground (hereinafter referred to as “Four Paws Playground”) and the Pet Owner whose signature appears below (hereinafter referred to as “Owner”). Four Paws Playground’s Agreement to Care for Owner’s Pet 1. Four Paws Playground shall exercise reasonable care for Owner’s Pet while Owner’s Pet is in Four Paws Playground custody. Owner recognizes the potential risks involved with group play and dog daycare, boarding, training and other events. Owner has determined that the benefits of these activities outweigh the risks. 2. Four Paws Playground reserves the right to refuse to provide daycare, boarding and/or training services to Owner’s Pet for any reason or no reason at all. Owner’s Representations 3. Owner represents that all information Owner has conveyed about Owner’s Pet to Four Paws Playground is fully accurate to the best of Owner’s knowledge. 4. Owner represents to Four Paws Playground that Owner’s Pet has not been exposed to rabies, distemper or any other contagious or communicable disease in the thirty (30) day period prior to being left for boarding, daycare, training, or any event hosted by Four Paws Playground. Owner agrees to notify Four Paws Playground if Owner’s Pet is exposed to any virus, infection or other transferable illness. Owner further agrees that Owner will not bring Owner’s Pet to Four Paws Playground unless and until Owner’s Pet is free of any symptoms of illness for a reasonable period determined by a licensed veterinarian. Owner further agrees not to bring Owner’s Pet to Four Paws Playground if Owner’s Pet is exhibiting any signs of illness that may be harmful to other dogs. Such signs of illness include, but are not limited to: vomiting, diarrhea, extreme lethargy and red eyes. 5. Owner represents that he or she is the sole owner of Owner’s Pet, free and clear of all liens and encumbrances. Owner’s Agreement to Pay for Services 6. Owner agrees to pay the rate for daycare, boarding and/or training in effect and published by Four Paws Playground on the date Owner brings Owner’s Pet to Four Paws Playground. 7. Owner agrees that if Owner’s Pet becomes ill or otherwise requires professional attention, Four Paws Playground, in its sole discretion, may take one or more of the following actions: (1) engage the services of a veterinarian or (2) administer medicine or (3) give other requisite attention to Owner’s Pet. Owner further agrees that the expenses incurred in treating Owner’s Pet shall be paid entirely by Owner. Owner hereby gives consent to Four Paws Playground to act as Owner’s agent in obtaining emergency veterinary care for Owner’s pet if such care is deemed appropriate by Four Paws Playground or any of its employees. Owner agrees to indemnify Four Paws Playground and its employees for all expenses incurred in treating Owner’s Pet. 8. Owner agrees to pay all charges stated in the Four Paws Playground Cancellation Policy. 9. All charges incurred by Owner shall be payable upon pick-up of Owner’s Pet or immediately upon receipt when billed by Four Paws Playground to Owner’s current address. Owner further agrees that Four Paws Playground shall have the right to refuse to release Owner’s Pet to Owner until Owner had paid all charges due. 10. Owner hereby grants Four Paws Playground a lien on Owner’s Pet for any and all unpaid charges resulting from boarding, daycare or any other service provided by Four Paws Playground. Owner’s Agreement to Indemnify Four Paws Playground for all Losses Caused by Owner’s Pet 11. Owner agrees to pay any and all expenses incurred by any person because of damage to real or personal property or bodily injury to any person caused by Owner and/or Owner’s Pet. Owner agrees to indemnify Four Paws Playground for any losses or liability incurred by Four Paws Playground caused by Owner and/or Owner’s Pet. Owner further agrees to assume all liabilities and responsibilities, financial or otherwise, for the behavior and health of the Owner’s Pet. Owner further agrees to hold Four Paws Playground harmless from any claims, actions, or demands against Four Paws Playground. Owner’s Agreement to Grant Four Paws Playground a Commercial License to Use Pet’s Image 12. Owner hereby grants Four Paws Playground the right to take photographs of Owner’s Pet and to post or reproduce any and all photographs taken (along with Owner’s Pet’s name) without limitation, on Four Paws Playground’s website and in Four PP’s promotional materials and merchandise. Owner expressly waives the right to receive any royalty or other payments of any kind related to the use of the photographs. Owner agrees not to sue Four Paws Playground and releases it from any and all claims, demands, rights, causes of action of any kind related to the use of photographs. Owner’s Agreement to Limitation of Four Paws Playground’s Liability 13. Owner agrees that Four Paws Playground’s liability to Owner for any reason shall in no event exceed the fair market value of Owner’s Pet. In consideration of the services rendered to Owner by Four Paws Playground, Owner waives any and all claims, actions or demands of any nature, foreseen or unforeseen, that he/she may have now, or in the future, against Four Paws Playground, relating to the care, control, health, and/or safety of Owner’s Pet arising during pick-up, transport, drop-off, and/or stay at Four Paws Playground. Miscellaneous 14. This Contract contains the entire agreement between the parties. All terms and conditions of this Contract shall be binding on the heirs, administrators, personal representatives and assigns of Owner and Four Paws Playground. Consent* I have read the Owner's Waiver of RightsCHECKING THE BOX INDICATES THAT YOU HAVE READ THE OWNER'S WAIVER OF RIGHTS. PoliciesPayments CASH or CHECK only. All checks returned will be subject to a $35.00 service charge. All payment is due at time of service. Refunds - All refunds will be in a form of credit at Four Paws Playground Boarding Cancellation Policy 24 hour notice required for general boarding stays and two (2) days’ notice required for boarding stays over holidays recognized by the US Postal Service. **Please NOTE! For the time periods November 22nd thru November 29th & December 22nd thru January 2nd, a three (3) day cancellation policy is in effect. If your reservation is NOT cancelled in accordance with our cancellation policy, you will be charged for the reservation in its entirety. Please understand our boarding space is in high demand & we strictly adhere to this policy. Thank you for your understanding! NO LATE PICK-UP Emergency Care In the case of accident or illness, Four Paws Playground will attempt to provide appropriate first aid and will notify the owner. If it is an emergency, we will take the dog to the vet. The costs of emergency medical care is the financial responsibility of the ill or injured dog’s owner. Photography Four Paws Playground reserves the right to take photographs and/or videos during daycare or any event at their facility, and to use those photographs and/or videos for marketing purposes. As a participant in daycare or an event, you therefore are agreeing to let your dog’s image be used in such photographs and/or videos. Parents who do not wish their dog’s images to be used in this manner should notify Four Paws Playground in writing before the event or daycare. Visiting any Dog Parks or Dog Events To prevent any unforeseen illness, all dogs that attend any type of dog park or dog event must wait two (2) weeks before attending daycare, boarding or training at Four Paws Playground. K - 9 Cough (Kennel) The first time your dog receives a Kennel Cough vaccination there is a TWO-week incubation period. Booster Kennel Cough vaccinations require a 48-hour incubation period. Please visit our youtube channel for more information on Kennel Cough. Office & Parking lot rules For everyone’s safety, when dogs are in the office and/or parking lot, please refrain from having the dogs interact with other dogs or jumping on the parents. Allow other clients to enter or exit the office area before entering with your dog. Please use the “Enter” door to enter and “Exit” when leaving. All dogs must be on leash when entering and exiting the building. Yearly Fecal Exam with Giardia Test For the health and safety of all of our clients, Four Paws Playground requires an annual fecal exam and Giardia screening (dogs 5 years and younger must have the Giardia test.) This is a simple stool exam conducted by your vet. New clients must be tested prior to entering daycare, boarding or training. Sorry for any inconvenience this may cause, but we must ensure a clean and healthy environment for ALL our dogs. Year Documentation Each year, our required documents (application, waiver and HIPPA) must be completed and signed. They are located on the website under the red button. Cell Phone Usage For safety there is NO cell phone usage while picking up your dogs in the office. Also if you are taking a tour there will to be no cell phone used for any reason. Dog food for Daycare and Boarding. When bringing food, all dog food needs to be labels and amounts per meal. By signing this, you have read, understand, and agree to all the policies listed above.Consent* I agree to Four Paws Playground Policies and I understand this will cover all and any future dogs that I may own.CHECKING THE BOX INDICATES THAT YOU AGREE TO OUR POLICIES.Payment* I understand that Four Paws Playground only accepts Cash or Checks. We DO NOT accept Credit Cards.CHECKING THE BOX INDICATES THAT YOU UNDERSTAND OUR PAYMENT POLICY. When Your Dog Cannot Attend Daycare or Boarding• If your dog is coughing/sneezing, has diarrhea, or is experiencing anything that is not normal, please do not bring him to daycare. He could be contagious. BY SIGNING THIS YOU AGREE THAT ALL INFORMATION PROVIDED IS ACCURATE AND AGREE TO ALL INFORMATION. Date* Date Format: MM slash DD slash YYYY Signature*Please type your name above to act as your signature.SignatureCommentsThis field is for validation purposes and should be left unchanged.
