Boarding Waiver – Dog Haven Animal Hospital Boarding Waiver – DogYour Name(Required) First Last Your Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Your Email Address(Required) Your Phone(Required)We use two-way texting to communicate with clients. We also send automatic reminders about appointments and services due. Standard messaging rates apply, and you may opt out anytime by texting STOPPet Name(Required)Pet Species(Required) Dog Pet Breed(Required)Pet Color(Required)Pet Age(Required)Pet Sex(Required) Male Female Spayed or Neutered?(Required) Yes No On a Flea and Tick Preventative?(Required) Yes No Proof of preventative is required. What are the primary reasons for bringing your dog to Haven Pet Lodge?(Required)How long have you had your dog?(Required)Where did you get your dog?(Required)Is there a person, type of dog, or situation your dog is uncomfortable with?(Required)Are there areas on your dog's body where he/she does not like to be touched by humans?(Required)Has your dog ever growled at or bit another person or dog?(Required)Can you take food items away from your dog without him/her growling?(Required)Has your dog ever jumped a fence or barrier?(Required)Has your dog ever socialized with a large group of dogs (8 or more)?(Required)Does your dog play well with dogs of all sizes?(Required)Are there any restrictions that should be placed on your dog's activities?(Required)Does your dog have any allergies or any other conditions?(Required)Is there anything else we should know about your dog?(Required)Haven Pet Lodge Waiver – Dog(Required) By checking this box I agree to the following terms:All Dogs Must: • Be current on rabies, distemper, parvo, bordetella and any other required vaccinations; • Be at least 4 months of age • Be spayed or neutered if 6 months of age or older to participate in group play • Be in good general health and free of fleas and ticks • Be non-aggressive towards other dogs and people • Be leashed when entering and exiting Haven Pet Lodge • Complete a pet interview prior to first reservation. – I understand that Haven Pet Lodge has relied upon my representation that my dog is in good health and has not injured or shown aggression or threatening behavior to any person or dog in admitting my dog for services at their facility. – I understand that Haven Pet Lodge owners, staff, partners, and volunteers will not be liable, financially, or otherwise, for injuries to my dog, myself, or any property of mine while my dog is participating in services provided by Haven Pet Lodge. I hereby release Haven Pet Lodge of any liability of any kind arising from my dogs’ participation in all services provided by Haven Pet Lodge. – I understand and agree that any problems with my dog; behavioral, medical, or otherwise, will be treated as deemed best by the staff of Haven Pet Lodge at their sole discretion and in what they view is in the best interest of the animal. I understand that I assume full monetary responsibility and all liability for all expenses involved in my dog’s behavior and health. – Socialization: I understand that there are risks and benefits associated with group socialization of dogs. I agree that the benefits outweigh the risks and that I accept the risk. I desire a socialized environment for my dog while attending services provided by Haven Pet Lodge and while in their care. I understand that, while the socialization and play is closely and carefully monitored by Haven Pet Lodge staff to prevent injury, it is still possible that during normal play my dog may receive minor nicks and scratches from roughhousing with other dogs. Any injuries to my dog will be pointed out by staff upon pick-up. – Food: Dogs will be fed in accordance with the instructions provided in the E-mail confirmation that you provide. You must provide commercial dog food in a container marked with your dog’s name and feeding instructions. – Media Release: I understand that by allowing my dog to participate in services offered by Haven Pet Lodge, I hereby agree to allow Haven Pet Lodge to take photographs or use images of my dog in print form or otherwise for publication and/or promotion. – Personal Property: Haven Pet Lodge will not be liable for any lost, stolen, or damaged individual property belonging either to you or your dog. If your dog causes any damage to Haven Pet Lodge, you will be liable for the full cost of all repairs and replacements. – Fees: You must pay for all services and products by cash or credit card, we do not accept checks. Full payment is due upon check-in. You give express permission for Haven Pet Lodge to charge any credit card you provide for unpaid services or products upon the date services have been completed. You further agree to pay any collection costs and the cost of any returned or challenged credit charges. – Aggressive Dogs: Although Haven Pet Lodge loves all dogs, to come to Haven Pet Lodge, your dog may not be aggressive and must pass Haven Pet Lodge interview process in Haven Pet Lodge’s sole discretion. Your dog may be separated from other dogs or asked to not return to Haven Pet Lodge if he/she exhibits aggressive or other unacceptable behavior in Haven Pet Lodge’s sole discretion. – Duty to Disclose: You must disclose all medical or other conditions, including personality concerns or behavioral incidents that may affect, limit, or prevent your dog’s ability to participate in any activity or service. In the event of a material change to the information you provided in this application; you agree to submit a new application within 7 days. – Acceptance and Acknowledgement of Risk: You fully understand that; • There are inherent and potential risks involved with interactions between humans and dogs, as well as between dogs and other dogs, which may result in property damage or bodily injury, including but not limited to, permanent disability, sickness or death to human or dog • There may be other risks not known to you or Haven Pet Lodge, nor readily foreseeable at this time (collectively, “risks”). You fully accept and assume all risks and responsibility for all risks, including, without limitation, all losses, costs, and damages incurred because of your dog’s participation at Haven Pet Lodge, including any veterinary expenses listed in Veterinary Care section below. “Sickness” includes any illness including but not limited to bordetella (kennel cough), bloat, canine flu, or any other form of contagious disease. • I am solely responsible, financially, or otherwise, for any harm or damage caused by my dog, while my dog is attending any services provided by Haven Pet Lodge. – Veterinary Care: Haven Pet Lodge will have the right to obtain medical treatment for your dog, if, in Haven Pet Lodge’s sole discretion, your dog may be ill, injured, or exhibit any other behavior that would suggest that your dog may need medical treatment. Reasonable efforts will be made to contact you when Haven Pet Lodge determines that medical treatment is necessary, but if Haven Pet Lodge is unable to contact you or your emergency contact, Haven Pet Lodge and veterinarian may rely on this Acceptance and Acknowledgement of Risk as your consent to treat your dog. You hereby grant the veterinarian and Haven Pet Lodge the right to make medically necessary decisions for your dog’s treatment and release the veterinarian and Haven Pet Lodge for all liability for the same. If you are unable to be reached but your emergency contact is reached, you hereby grant your emergency contact the right to make medically necessary decisions for your dog’s treatment. In the event your dog is injured during routine play, we presume that no dog is at fault, and you agree to be fully responsible for all resulting costs related to any medical treatment for your dog(s), including without limitation, the cost of any transportation for the purpose of such treatment. If Haven Pet Lodge staff determines, in their sole discretion, that your dog caused injury or death of another dog outside of routine play, you will be fully responsible for all costs related to any medical treatment for the injured dog(s), including without limitation, the cost of any transportation for the purpose of such treatment. – Abandonment: I understand that if my dog is not checked out on time, I hereby authorize Haven Pet Lodge to take whatever action is deemed necessary for the continuing care of my dog. I will pay Haven Pet Lodge the cost of any such continuing care upon demand. I understand that if I do not pick up my animal, Haven Pet Lodge will proceed according to the guidelines provided by Section 1834.5 and 1834.6 of the California Civil Code. I also acknowledge that I will be fully responsible for all attorney fees and associated costs if I abandon my dog. – Haven Pet Lodge is owned and operated by Haven Animal Hospital Vaccine RecordsMax. file size: 512 MB. Local emergency contact that can pick up your pet(s) in case of emergency, should you be out of town or unavailable.(Required) First Last Phone(Required)CAPTCHASomeone from our team will contact you in 1-2 business days to confirm the details of your appointment. Our office is closed Saturday, Sunday and Monday.
