Dog Story LLC ENROLLMENT FORM
We are thrilled your dog will be joining the fun here at Dog Story LLC!Please fill out the forms below, save and email to
your preferred location. You can find each Dog Story LLC location's email address on the Store Info page in the About Us section of their website. Please bring vaccination records with you or your veterinarian's office may fax or email them ahead of your appointment.
Pet Parent Profile
Pet Parent #1:
Cell:
Address:
Home Phone:
Email:
Employer:
Work Number:
☐ Please check if you DO NOT wish to receive Dog Story LLC updates and special offers via email. We do not sell information to third parties.
Pet Parent #2: Cell:
Address:
Home Phone:
Email:
Employer:
Work Number:
☐ Please check if you DO NOT wish to receive Dog Story LLC updates and special offers via email. We do not sell information to third parties.
Number of pets enrolling/enrolled at Dog Story LLC:
Emergency Contact (if owner(s) cannot be reached)
Name:
Phone:
Relation to Family: Email:
Veterinarian Veterinarian Name:
Hospital Name:
Phone Number:
City & State:
(In the event of an emergency, you will be notified and your dog will be taken to the nearest vet.)
How did you hear about us?
(check all that apply)
☐ Community Event* ☐ Rescue/Shelter* ☐ Internet Search ☐ Advertisement ☐ Article/TV News
☐ Veterinarian/Trainer* ☐ Drive-by ☐ Existing Client* ☐ Other*
*Please Specify:
PET PARENT AGREEMENT
I,
, hereby certify that my dog(s),
is/are in good health, have not been ill with any communicable diseases or
parasites in the last 30 days, and have not harmed or shown aggressive or threatening behavior towards any person or any other dog. I also have read and understand and agree to the following:
1.
Inherent Risks of Play, Spa & Grooming. I understand that Dog Story LLC is an open-play environment and because of this
there are inherent risks, which even when closely monitored, may result in the following:
a.Transfer of communicable parasites or an illness such as, but not limited to, the canine papilloma virus also known as
“puppy warts,” or an upper respiratory illness like Kennel Cough, which can be caused by a contagious bacteria or virus.
b.Injuries, usually benign, such as broken nails, sore pads, puncture wounds, abrasions and cuts, particularly in shorter coated breeds, etc.
c.Behavioral problems.
I also understand that if my dog(s) has/have spa or grooming services, my dog(s) is/are at inherent risk for skin irritation, shampoo
in eyes, risk of cuts, nicks, scratches, cutting of the nail quick, etc.
2.
Pet Health Issues While at Dog Story LLC. If health or behavioral problems develop with my dog(s), that these will be treated
as deemed best by the staff of Dog Story LLC within their sole discretion, and that I assume full financial responsibility for any and all expenses involved. If my dog(s) become(s) ill or injured, or is suspected to be ill or injured, or if for any other reason veterinary care is indicated, I authorize Dog Story LLC to seek and provide veterinary care from my designated veterinarian or a veterinarian of their choice. If my dog’s condition is emergent, I understand Dog Story LLC will seek care at the closest veterinarian office location. During my absence, Dog Story LLC will be caring for my dog. In the event of an emergency, I authorize the release of all medical records pertaining to the medical needs of my dog(s) to Dog Story LLC and all subsidiaries. I give representatives of Dog Story LLC authorization to communicate with said veterinarian regarding, diagnosis, prognosis and treatment of my dog(s). _________________(Initial)
In the rare and unfortunate event that my dog becomes deceased while in Dog Story LLC’s care, my dog will be taken to my designated
veterinarian and maintained for pick-up or further instruction.If a necropsy is performed, I give permission for the veterinarian to release any and all findings to Dog Story LLC and all subsidiaries. _________________(Initial)
3.
Liability Release. Dog Story LLC and their team will not be liable for any health or behavioral problems that develop in my
dog(s), and I hereby release them of any liability of any kind whatsoever arising from my dog(s) attendance and participation at Dog Story LLC. I am solely responsible for any harm, including to any other dog(s), to the employees or invitees of Dog Story LLC, or to the equipment, physical plant, or other property of Dog Story LLC, caused by my dog(s) while my dog(s) is/are attending Dog Story LLC.
4.
Preventative Maintenance Commitment. I agree to maintain regular flea, tick, and heartworm preventative maintenance
programs for as long as my dog(s) has/have active attendance and participation at Dog Story LLC.
5.
Crate Training. I authorize my dog(s) to be placed in a crate during boarding and/or daycare.
6.
Photography Release. Photographs or other graphic, sound, or other image, likeness, recording, etc., may be made of
my dog(s) by Dog Story LLC and that such may be used for any purpose without compensation, and I release to Dog Story LLC all rights that I may possess or claim to such image, likeness, recording, etc.
7.
Fees & Payments. Payment is required when services are rendered. If any amounts remain due after 30 days, Dog Story LLC
reserves the right to impose interest at the rate of 1.5% per month until paid. If Dog Story LLC pursues collection proceedings, I will pay reasonable attorney’s fees and costs of collection.
8.
Hours of Operations & Late Pick-Up Fees. Please refer to our brochure or website for store hours. We reserve the right to impose a late fee for dogs picked up after regular business hours. If your dog is not picked-up within 30 minutes of closing, we will assume that you are boarding and will impose an overnight boarding charge.
I have read and understood all terms of this agreement.
PET PARENT
Signature Date
Printed Name
PICK-UP PERMISSION LIST
Name:
Relation to dog(s):
Phone:
Email:
Name:
Relation to dog(s):
Phone:
Email:
Name:
Relation to dog(s):
Phone:
Email:
I acknowledge that by listing this/these person(s) as authorized to pick up I am relieving Dog Story LLC of all liabilities in giving this
person my dog(s).
Signature Date
PET PROFILE
Dog’s Name:
Breed/Description:
Date of Birth: Sex ☐ Female ☐ Male
Color: ☐ Yes ☐ No ☐ Too young to neutered/spayed
(All dogs over the age of 7 months old, or those exhibiting early onset adolescence, must be spayed/neutered.)
Where did you acquire your dog? ☐ Breeder ☐ Rescue/Shelter ☐ Re-homed ☐Found Additional Info: Date Acquired:
What type of food is your dog fed? How much?How often? __
Does your dog have any know allergies?
May we offer your dog treats? ☐ Yes ☐ No
Behavior & Animal Interactions (check all that apply)
☐ Has attended daycare ☐ Toy play permitted in an open-play environment ☐ Allowed to have treats Can food or toys be taken away from your dog without difficulty?
☐ Goes to the dog park ☐ Altercation with a dog ☐ Growled / snapped at another dog or human
How does your dog react to other dogs approaching when you’re on a walk?
☐ On Leash: ☐ Off Leash:
How does your dog react to dogs that are much larger or much smaller?
☐ Crate-trained ☐ Displays leash aggression ☐ Can escape crate ☐ Climbs / Jumps fences**
When crated, is your dog prone to rubbing his/her nose on crate or chewing on crate or tray? ☐ Yes ☐ No ☐ Displays separation anxiety ☐ Has bitten someone ☐ Has formal training
☐ Prone to eating stool or foreign objects** ☐ Fearful/Shown Aggression toward a dog or human
☐ Dislike or fear of any particular kind of dog or human attribute (e.g. herding dogs, men, mustache, hats) **
Health History
(check any that have occurred in the last 6 months)
☐ Ear Infections
☐ Eye Infections ☐ Allergies ☐ Gastritis/Bloat
☐ Heartworms
☐ Tapeworms
☐ Canine Cough ☐ Heat Stroke ☐ Seizures
Additional Health Concerns
☐ Heart
☐ Vision ☐ Hearing ☐ Skin
☐ Hip/Bone
☐ Surgeries:
Preventative Health Maintenance (please indicate brand used)
☐ Current flea and tick preventative: ☐ Current heartworm preventative:
Pet Services Services Interested in:
☐ Daycare ☐ Boarding ☐ Spa ☐ Grooming ☐ Other:
If your dog is receiving spa or grooming services, would you like us to use pet cologne? ☐ Yes ☐ No Does your dog have any known allergies to any pet spa or grooming products?
