For the safety of your dog, please include all the information that can help us care for them the best. Dog Information Veterinary Release Form Dog and Daycare Information FormYour Name *Your Dog's Name *File out this form one submission per dog.Email *Phone *HTML**An emergency contact is someone who is not traveling with you.**Emergency Contact Name *Emergency Contact Phone *Field Group - Dog health basicBoarding & Daycare AgreementDog InfoName (nickname)Dog's ageBirthdate (if known)SexFemaleMaleDoes your dog have any health concerns?Does your dog have any restrictions on activity?Is your dog on any medications? If so, please name them.Does your dog receive heartworm, flea and tick preventatives? Please name them.Please check any boxes that apply to your dogMellow/CalmShy/SubmissivePlayfulHigh EnergyDominant/AlphaWell-BehavedUnrulyPeople AggressiveDog AggressiveToy PossessiveVocalHigh StrungEscape ArtistRough playerExcessive BarkerDiggerGrowls at StrangersEats RocksFeces EaterHas Separation AnxietyDestroys FurnitureRuns AwayFear of Loud NoisesJumps FencesDestroys ToysExcessive ChewerPlease elaborate on any of the above if you wish. Information Accuracy: The Owner confirms the accuracy of all information provided about their pet(s) to Dog E Central. Medical Records Authorization: The Owner authorizes Dog E Central to obtain the pet(s)' medical and vaccination records from the veterinarian listed above, and the veterinarian is authorized to provide these records to Dog E Central. Health Condition Disclosure: The Owner agrees not to bring pet(s) to Dog E Central if they show signs of illness (vomiting, diarrhea, coughing, etc.) that could harm other pets without prior approval from Dog E Central. Reasonable Care and Risk Acknowledgement: Dog E Central will exercise reasonable care for the Owner's pet(s) while in its custody. The Owner understands the potential risks (illness, injury) associated with daycare, boarding, and grooming. Dog E Central does not accept aggressive pets. Safety Measures: Dog E Central may adjust the type of daycare/boarding or remove pet(s) from group play if deemed necessary for the safety of the Owner's pet(s), other pets, or employees. Owner Representation: The Owner confirms being over 18 years old and that all provided information, including credit card details, is accurate. Policies and Procedures: The Owner agrees to the Policies and Procedures posted in the Dog E Central lobby and on its website on the check-in date. Dog E Central may adjust these policies without prior notice. Veterinary Care Authorization: The Owner consents to Dog E Central obtaining veterinary services if their pet(s) become ill. Dog E Central may engage such services at the Owner's expense, and the Owner agrees to indemnify and hold Dog E Central harmless from these expenses. Payment Agreement: The Owner agrees to pay for all services, including special requests, veterinary costs, and fees resulting from cancellations not complying with Dog E Central's Cancellation Policy. Lien on Pet(s): Dog E Central may retain the Owner's pet(s) until all charges are paid and is granted a lien on the pet(s) for any unpaid charges. Liability for Pet(s)' Actions: The Owner assumes all liability and expenses for injuries their pet(s) cause to humans or other animals at Dog E Central and indemnifies Dog E Central and its employees from such liability. Media Release: The Owner allows Dog E Central to take and use photos/videos of their pet(s) for promotional purposes without compensation. The Owner releases Dog E Central from any related claims and agrees not to take photos/videos at Dog E Central without written permission. Liability Limit: Dog E Central's liability is limited to the current market value of a pet of the same species. Entire Agreement: This Agreement represents the entire understanding between the parties and binds their heirs,representatives, and assigns. Printed Name *Signature *Start signing your signature hereYour browser does not support e-Signature field.Date *Register Veterinary Release Form Dog e Central requires all clients to complete a Veterinary Release Form. In the event of an emergency, Dog e Central will make every attempt to contact the owner, the secondary owner and the emergency contact. In the event that no contact can be reached, Dog e Central will seek appropriate medical care for your pet(s). Dog e Central will make every attempt to take your pet(s) to the Veterinarian listed blow, however, if your Veterinarian is not available, Dog e Central will bring your pet(s) to an appropriate clinic.Your Name *Your Dog's Name(s) *Email *Phone *Field Group - Vet infoVeterinarian InformationVeterinarian nameOffice name *Street Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Office phone *Yes, I agree to the following: In the case of an emergency, I understand that Dog e Central will make every attempt to contact the primary owner, secondary owner and emergency contact. If no contact can be reached, I authorize Dog e Central to seek appropriate medical treatment for my pet(s). I understand that every effort will be made to take my pet(s) to the above Veterinarian, however, I authorize Dog e Central to seek treatment for my pet(s) any appropriate clinic, if necessary. I authorize Dog e Central and the Veterinarian caring for my pet(s) to share all medical records of my pet(s) with emergency vet clinics in an effort to provide the best care possible. I agree to assume full responsibility for payment and reimbursement for any and all veterinary services rendered. I understand that Dog e Central assumes no responsibility for the loss or injury of any pet(s) and is released from all liability related to transportation, treatment and expenses. This agreement is valid from the date below and grants permission for all future veterinary care without additional authorization each time Dog e Central cares for my pet(s). I give permission to Dog e Central to approve treatment up to: *no limit$250$500$1000Printed Name *Signature *Start signing your signature hereYour browser does not support e-Signature field.Date *Register