Doggie Daycare Application

Noah's Bark asks that dog owners complete an application prior to your assesment appointment. The information included on these forms allows us to know your pet a little better. You can fill out the application below:

Basic Information
Name:
Phone:
Bus. Phone:
Street Address:
City:
State:
Zip:
E-mail address:
Where can we reach you (if necessary):
Phone:
Who is responsible for your pet(s) in the event of your illness or death:
How can we reach them:
Name of people authorized to pick up/drop off pet(s):


Pet Information

Pet Name:
Type of Pet
Male or Female: Male Female
Pet Breed:
Age:
Spayed / Neutered: Yes No
Weight:
Color:
Special Markings:

AGREEMENT AND RELEASE/HEALTH AND TEMPERAMENT

1. In agreement of being permitted to use the services and facilities of Noah's Bark Doggie Day Care, LLC (Noah's Bark), I/we, the undersigned owner(s), hereby release, waive, and discharge Noah's Bark owner, staff, and volunteers from all liability for any and all loss or damage, and any claim or damages resulting there from, on account of injury, loss, damage, infestation, or disease to my/our pet(s) even injury resulting in death, whether caused by the negligence of Noah's Bark, its owner(s), staff or volunteers or otherwise while my/our pet(s) are under the care of Noah's Bark.

2. I/we agree to indemnify Noah's Bark, its owner, staff, and volunteers for any loss, liability, damage, or cost they may incur due to my/our presence or the presence of my/our pet(s) in or upon Noah's Bark premises and while my/our pet(s) is/are under the care of Noah's Bark.

3. I/we hereby assume full responsibility for any harm caused by my/our pet(s) while in or on the premises and while my/our pet(s) is/are under the care of Noah's Bark. I/we further agree to indemnify Noah's Bark, its owner, staff, and volunteers for any loss, liability, damage, or costs they may incur due to any harm caused by my/our pet(s).

4. I/we expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Ohio, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

5. I/we further understand and agree that in admitting my/our pet(s) to Noah's Bark, the owner(s) of Noah's Bark have relied on my/our representation that my pet(s) is/are in good health and has/have not harmed or shown aggression or threatening behavior toward any person or any other pet.

6. I/we agree that should a court determine that any provision waiving liability is deemed unenforceable, Noah's Bark' liability shall be limited to the funds paid to it by me for taking care of my/our pet(s).

7. I/we further understand and agree that any injury or illness that develops with my/our pet(s) will be treated as deemed best by Noah's Bark, and that I/we assume full financial responsibility for any and all expenses involved, even if such expenses were later found to be unnecessary. Furthermore, should my/our pet(s) pass away during my/our absence, I/we direct that a veterinarian may be called to safe keep my/our pet(s) until our return.

8. I/we have read and understand the attached Rules and Regulations and agree to abide by them. I/we certify that I/we have read and understood the Agreement and Release and agree to accept all the terms and conditions and statements of this agreement.
AGREEMENT AND RELEASE/HEALTH AND TEMPERAMENT
Today's Date
Printed Name of Owners


Veterinary Release Form

Type Of Animal:
Pet's Name
Age:
Veterinarian:
Yes No
Address:
Veterinarian's Phone:
Medical Conditions:

During my absence, Noah's Bark Doggie Day Care will be caring for my pet(s). In the event of an emergency, I authorize you (veterinarian) to administer medical treatment and will be responsible for payment to you (veterinarian) upon my return.

I, , give Noah's Bark Doggie Day Care permission to transport my pet(s) to the above veterinarian in the event of an emergency or sickness.

If this veterinarian is not available, I authorize Noah's Bark Doggie Day Care to transport my pet(s) to a veterinarian of choice and authorize treatment. If emergency care is needed after regular office hours, my pet(s) may be taken to the nearest Veterinarian Emergency Clinic/Hospital.

I give permission to provide treatment up to $.

I agree that Noah's Bark Doggie Day Care is released from all liability related to transportation to and from veterinarian and treatment for sickness or emergency.

I agree to authorize veterinarian to euthanize my pet in extreme circumstances after all reasonable attempts have been made to reach my emergency contact or myself.

This agreement will remain valid for all visits unless a new one is signed.


Pet's Health Record (must be accompanied by veterinarian records or we can contact your vet):
Date of Last Check-up:
Flea/Tick Preventative:
Any known allergies:

Vaccination Dates:
Rabies:
DHLP:
Parvo:
Bordatella:

NOAH'S BARK DOGGIE DAY CARE, LLC, RULES AND REGULATIONS

The purpose of Noah's Bark Doggie Day Care, LLC, is to provide a safe, fun, and stimulating environment for your pet. To ensure the safety and health of your pet and of our other guests, we require all of our guests to comply with the following rules and regulations:

AGE: The breed of the dog and its temperament determines minimum age.

SEX: All dogs must be spayed or neutered by seven months of age..

IMMUNIZATIONS: All pets must have up-to-date vaccinations. Owners must submit written proof that their pet received DHLPP, Rabies, and Bordatella vaccinations within the past 7 days to 11 months. Specifically, the vaccines required are Distemper, Hepatitis, Leptospirosis, Parafinfluenza, Parvovirus, and Bordatella. These immunizations are more commonly referred to as DHLPP, 5-in-1 or 6-in-1. The Bordatella nasal spray may have been given as a separate immunization.

HEALTH: All pets must be in good health. Owners will need to certify that their pet(s) are in good health and have not been ill in the past 30 days. On admission, all pets must be free from any condition, which could potentially jeopardize other guests. Pets that have been ill with a communicable condition in the last 30 days will require a veterinarian certification of health to be admitted or re-admitted.

BEHAVIOR: All pets must be non-aggressive and not food or toy protective. Owners will need to certify that their pet(s) have not harmed or shown any aggressive or threatening behavior towards any person or any other pet.

APPLICATION: All pets must have a complete, up-to-date and approved application on file.

FEES: Fees are due and payable in advance daily or weekly.

DAYS AND HOURS: Monday through Friday from 7:00 a.m. to 7:00 p.m. Saturday 8:00 AM until 5:00 PM. Your pet may not be dropped off before 7:00 a.m. and not be left here after 7:00 p.m. (8 am – 5 pm on Saturdays) unless special arrangements have been made in advance. There will be a charge of $5/15 minute intervals for any pet remaining after 7:00 p.m.

RESERVATIONS: Preference will be given to pets attending full-time. Cancellations with less than 24 hours notice will be charged full fees.
I have read, understood, and agree to the information above.
Pet's Name:
Species / Breed:

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