Birthday

Neutered MaleSpayed FemaleToo Young

Date: Spay/Neuter (required)

Behavior: (check all that apply)
Has attended daycareGoes to the dog parkCrate - trainedDisplays leash aggressionDisplays separation anxietyHas bitten someoneHas formal trainingAltercation with a dogCan escape crateProne to eating foreign objects/poopLives with other household pets

Health History: (check any that have occurred in the last 6 months if any)
Ear InfectionsEye InfectionsAllergiesGastritis/BloatHeartwormsTapewormsCanine CoughHeat StrokeSeizuresSurgeriesRegular Medications

Owner #1 Name

Owner #2 Name

Emergency Contact: (if owner(s) cannot be reached)

Veterinarian

**Boarding extremely old, chronically ill or otherwise debilitated pets requires extra care, which our caring and trained staff is happy to provide. However, special needs pets, puppies and senior pets naturally have a higher risk of injury, stress related illness, or exacerbation of any preexisting condition. As such, by boarding your special needs pet, puppy or senior pet with us you are waiving any claim for injury or illness experienced by your pet while in our care and that is not directly caused by the negligence or lack of care on the part of our staff.
I Accept

**Owner understands and agrees that Owner’s dog will be in the group with other
dogs. During normal dog play, Owner’s dog may sustain injuries. All dog play is monitored by Daycare attendants to avoid injury, but scratches, punctures, torn ligaments, and other injuries may occur despite the best supervision. Learning
Pawsibilities will not be held responsible for those injuries.
I Accept

Owner further understands and agrees that neither Learning Pawsibilites nor any of its employees, staff or volunteers, will be liable for any illness, injury, death, and/or escape of Owner’s dogs.
Dog(s) provided that reasonable care and precautions are followed, and Owner hereby releases all of them of any liability of any kind whatsoever arising from or as a result of Owner’s dog(s) attending or participating at Daycare, Boarding, Training, Pet sitting, Dog Walking, Pet Taxi or Grooming.
I Accept

Owner further understands and agrees that Owner’s dog(s) are healthy and will at all times while attending Daycare, Training, Boarding or Pet Sitting have current vaccinations. Owner is not enrolling any dog in Daycare, Training or Boarding 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 is vaccinated for Bordatella (Kennel Cough) there is a chance that the Owner(s) dog can still contract Kennel Cough. I agree that I will NOT hold Learning Pawsibilities responsible if Owner’s dog(s) contracts Kennel Cough.
I Accept

In the event of illness or injury, I authorize Learning Pawsibilities to seek appropriate medical treatment for my pet.
I understand that every effort will be made to take my pet to the vet clinic specified on the emergency form if the situation permits however; Learning Pawsibilities has the authority to seek treatment at any veterinary clinic.
Furthermore, I agree to reimburse Learning Pawsibilities within 14 days of incident for veterinary fees and all related costs including transportation in any amount up to (required) ---$200.00$300.00$500.00$700.00$800.00$1000.00$1500.00Unlimited (please specify dollar amount per pet from drop down menu above. Common amounts are $200, $1000, or unlimited).

This release does not expire and will remain valid for all future Learning Pawsibilities services.

Services Interested in (required):
DaycareBoardingDog TrainingBathPet SittingDog Walking

Please Upload Vaccination Records Here. File types:pdf|doc|docx|jpeg|jpg (10MB max)

Your Name (required)

Your Email (required)