6440 Memorial Drive

Sandston, VA 23150

804-737-5300

PET SERVICES

BOARDING RULES AND LIABILITY RELEASE

CLIENT NAME: ______DOG(S) NAME: ______BIRTH YR:______EMAIL:______NAME: ______BIRTH YR:______

ADDRESS: ______

YOU MUST FURNISH A COPY OF YOUR DOG(S) VACCINATION RECORDS

VET:______RABIES TAG #(S): ______DATE EXP.______

BORDATELLA: ______EXP. ______

FLEA/TICK PREVENTION: ______LAST GIVEN: ______

LEGAL OWNERSHIP & RESPONSIBILITY

You certify that you are the legal owner of the dog(s) being boarded or an authorized representative for the legal owner and as such will accept full legal and financial responsibility. You understand that your dog(s) will only be released to you or your authorized representative(s) named below.

AUTHORIZED REPRESENTATIVE(S): ______

BOARDING FEES AND GUIDELINES

BOARDING FEES: A daily boarding fee is charged for each day your dog is present at Canine Works, including the day of admitting and pickup. Daily boarding fee: $25 Daily daycare fee: $20 (less than 10 hrs.)

CHOSEN PLAN: BOARDING WITH DAYCARE WITHOUT DAYCARE DAYCARE ONLY

CHEWERS AND EATER: MY DOG DOES NOT DOES CHEW OR EAT BEDDING OR TOYS

If we observe your dog eating or chew his bedding or toys we will remove the item.

AGGRESSIVE DOGS: Please let us know if your dog(s) can be aggressive towards people or other dogs so we can take proper precautions to ensure the safety of our staff and other dogs.

MY DOGIS AGGRESSIVETOWARDS PEOPLE/DOGS

MY DOG IS NOT AGGRESSIVE TOWARDS PEOPLE/DOGS

MEDICAL EMERGENCIES/SICKNESS/LOSS

In the event your dog becomes sick we will attempt to contact you or your listed emergency contacts. By listing an emergency contact you give them authorization to make all decisions about your dog if you cannot be reached. If we cannot contact you or your emergency contacts or in the event an emergency occurs, you give permission for the doctors and staff at Canine Works, LLC to provide whatever medical and/or surgical treatment is necessary for your dog and understand that you agree to accept responsibility for all fees. You understand that if your dog becomes sick or requires emergency care, there is no guarantee of a favorable outcome and you will still be responsible for all fees. You agree to release Canine Works, LLC and its staff of all liability associated with boarding your dog.

I CAN BE REACHED AT THIS PHONE NUMBER(S):______

#1 EMERGENCY CONTACT: ______

#2 EMERGENCY CONTACT: ______

PAGE 2 BOARDING DAYCARE FORM CANINE WORKS, LLC 804-737-5300

FLEAS AND TICKS

We keep our facility flea and tick free. All dogs will be checked for fleas and ticks at admittance if ticks are found they will be treated at your expense. If fleas are found on your dog he/she CAN NOT STAY WITH US.

COMMANDS

Please list any commands your dog knows and any special instructions we may need. Include places your dog likes to be pet and does NOT like to be pet. : ______

______

SNACKS

We supply milkbone type dog biscuits to all our boarders and daycare dogs. If your dog CANNOT have these type of snacks please let us know and if necessary please provide the snack that your dog can enjoy.

FEEDING

FEEDING: FOOD TYPE: ______CUPS: ______TIMES PER DAY:______

SECOND DOG: FOOD TYPE: ______CUPS:______TIMES PER DAY:______

OTHER INSTRUCTIONS: ______

______

MEDICATIONS

Please bring your dog’s medication along with clear instructions as to how your dog is medicated. In the event you do not provide us with instructions, we will follow the instructions on the medication container or use our best judgment. If your dog runs out of medication we will NOT fill the prescription.

MY DOG IS NOT ON ANY MEDICATION

MY DOG IS ON THE FOLLOWING MEDICATIONS-THEIR INSTRUCTIONS ARE PROVIDED: ______

______

CLIENT ITEMS

We prefer not to board your dog with personal items as they can become lost, destroyed or badly soiled and may need to be disposed of for sanitary health reasons. If you leave items with us, including leashes and collars, we cannot be responsible for those items as they may be destroyed, soiled or disposed of and you will not be refunded money to replace or repair the items.

STRESS RELATED PROBLEMS

All boarded dogs, even fully vaccinated dogs, placed in different or stressful situations may suffer decreased immunity and gastric changes. Vaccines do not protect against all disease. All boarded dogs become susceptible to sore throats, voice changes, canine cough, diarhea, constipation,excessive grooming and shedding. We cannot be responsible for costs associated with these conditions if they arise during or after boarding and you agree not to hold us liable for any costs associated with these conditions. Canine Works, LLC will make reasonable attempts to accommodate your dog but this may not be feasible in all cases.

BOARDING EXTENSIONS

Unforeseen events do occur. In the event that your dog cannot be picked up on the designated day, call us prior to the discharge day or as soon as reasonably possible to inform us of the delay and provide us with a new discharge day. Dogs left for more than 5 days passed the discharge date without owner contact will be considered abandoned. Please take our business card with you as it contains all contact information for our facility.

I have read, fully understand and agree to the conditions of the Boarding Rules and Liability Release form. This form is intended to be legally binding for the year 2014.

______

NAME OF OWNER OR AUTHORIZED AGENT SIGNATURE OF OWNER OR AUTHORIZED AGENTDATE