Pet Service Agreement - Five Star Dog Resort

OWNER’S INFORMATION

OWNER’S INFORMATION

Owner *

Address

City/State

Zip Code

Home Ph.

Cell *

Work/Other

Email *

Name of Emergency Contact *

Phone No. of Emergency Contact

Tell us how you heard about us:

Referral

Website/Internet

Drive-by

PET(S) INFORMATION

PET(S) INFORMATION

Repeater

Pet Name

Breed

DOB

Color

Gender

Weight

Spayed/Neutered

Add Remove

Name of Veterinarian

Address

City

State

Phone No.

Instruction

PETS MUST BE CURRENT ON ALL VACCINATIONS. PLEASE SUBMIT COPY RABIES, BORDETELLA, DHPP REQUIRED

List Flea and Heartworm Preventative and date last given to Pet

Pet is Known to:

(Extra fee for aggressive pets. List all traits.)

MEDICAL CONDITIONS:

ALLERGIES: OWNER MUST LIST ALL ALLERGIC SUBSTANCES, INCLUDING FOOD ALLERGIES TO HUMUAN OR DOG FOODS):

MEDICATIONS (LIST ALL):

Medications

Add Remove

TOTAL NO. MEDICATIONS:

DAILY ADMINISTRATION:

OWNER MUST LIST THE MAX DAILY DOSAGE ALONG WITH THE FREQUENCY OF DOSAGES:

Instruction

ACCEPTANCE AND ACKNOWLEDGMENT OF FIVE STAR DOG RESORT (or “facility”) PARTICIPATION RISK. (a) In the event of any medical conditions and/or medications listed above, the following information must be completed by the Pet Owner. By signing this Agreement, the Owner understands and agrees that Five Star is not a medical facility, and the staff are not medically trained. As provided in this Agreement, the Owner releases Five Star and its staff from any liabilities. ALL MEDICATIONS MUST BE IN THEIR ORIGINAL CONTAINER(S) WITH YOUR PET’S NAME, OWNER’S NAME, AND CURRENT DOSAGES CLEARLY LISTED ON THE CONTAINER(S).

INITIALS:

Clear

I. MEDICATION NAME(S):

II. MEDICATION INSTRUCTIONS (TIME OF DAY TO ADMINISTER, DOSAGE AMOUNTS, TIMES PER DAY AND HOW GIVEN):

III. ILLNESS(ES) OR CONDITIONS TO BE TREATED:

IV. MEDICATION TYPE IV. MEDICATION TYPE

Hold on CTRL and click to select multiple items.

V. SIDE EFFECTS OF MEDICATIONS:

VI. HOW LONG PET HAS BEEN TAKING MEDICATION(S):

VII. WHEN WERE MEDICATION(S) BEGUN:

VIII. ARE MEDICATIONS FOR MAINTENANCE OR SHORT-TERM CONDITION?

IX. LAST DATE OF PET’S VISIT TO VETERINARIAN

X. LIST ALL VETERINARIAN’S INSTRUCTIONS, ADVICE AND CAUTIONS CONCERNING ANY PET MEDICATIONS:

XI. WILL THE COURSE OF TREATMENT REQUIRING MEDICATIONS BE COMPLETED WHILE YOUR PET IS IN OUR CARE?

XII. IF THE ANSWER TO THE ABOVE IS NO, WHEN WILL THE TREATMENT BE COMPLETED?

XIII. FILL OUT AND SIGN THE ATTACHED MEDICATION ADMINISTRATION LOG WHICH WILL BE USED BY FIVE STAR EMPLOYEES FOR MEDICINES

XIV. ARE ANY MEDICATIONS A NEW DRUG OR EXPERIMENTAL DRUG OR EXPERIMENTAL TREATMENT?

XV. IF ANSWER ABOVE IS YES, EXPLAIN FULLY

Instruction (b)

(b). Owner represents that to the best of owner’s knowledge the pet has not been exposed to any contagious diseases within a 30-day period prior to check-in, and that the pet has had all required immunizations and vaccinations and will be maintained as such. Owner has been informed that the facility’s employees are not veterinarians, do not have background in animal medicine, and are not expected to diagnose or detect animal illnesses. In addition, owner is aware that medications, immunizations, and vaccinations do not protect against all illnesses that may affect a pet. Owner voluntarily assumes all risk of illness, disease or harm that may befall owner’s pet by allowing pet to stay at the facility.

Instruction (c)

(c). Owner represents that to the best of his/her knowledge the raw pet food that owner has left for his/her dog(s) has been kept at the recommended temperature prior to bringing to Five Star Dog Resort. Owner is aware that raw dog food is susceptible to contamination and may subject the dog(s) to salmonella poisoning or other bacterial infections. Owner has been informed that the facility’s employees are not veterinarians, do not have background in animal medicine, and are not expected to diagnose or detect animal illnesses. Owner voluntarily assumes all risk of illness, disease or harm that may befall owner’s pet by feeding pet raw food.

Instruction (d)

(d). Also, Owner agrees that if any fleas or ticks are discovered on the pet, the facility may administer a flea bath at owner’s expense, and facility may administer spot flea and tick treatments to any pets checking the facility. Owner fully understands that there are inherent and potential risks involved with interactions between pets and other pets, which may result in property damage or bodily injury, including but not limited to disability, sickness or death to human or pets; and there may be other risks not known or readily foreseeable at this time (collectively “risks”).

Instruction (e)

(e). OWNER FULLY ACCEPTS AND ASSUMES ALL RISKS AND RESPONSIBILITY FOR ALL RISK INCLUDING, WITHOUT LIMITATION, ALL LOSSES, COSTS AND DAMAGES INCURRED AS A RESULT OF OWNER OR PET’S PARTICIPATION IN BOARDING OR DAY STAY, INCLUDING ANY VETERINARIAN EXPENSES INCURRED ON BEHALF OF OWNER’S PET; INCLUDING ANY INJURY OR ILLNESS; AND INCLUDING BUT NOT LIMITED TO, BORDETELLA (KENNEL COUGH) AND /OR ANY OTHER FORM OF INJURY OR ILLNESS.

INITIALS:

Clear

Instruction 2

2. VETERINARIAN LIABILITY. Owner agrees to allow the facility to obtain medical care for the pet if in facility’s sole discretion it appears that the pet is ill, injured or exhibits any other behavior that would reasonably suggest that the pet may need medical observation, diagnosis, or treatment (“medical care”). OWNER AGREES THAT OWNER IS FULLY RESPONSIBLE FOR THE COST OF MEDICAL CARE AND FOR THE COST OF TRANSPORTATION FOR THE PURPOSES OF SUCH MEDICAL CARE PROVIDED TO THE PET.

INITIALS:

Clear

Instruction 3

3. WAIVER RELEASE AND INDEMNITY. OWNER EXPRESSLY AND FOREVER GENERALLY WAIVES, DISCHARGES CLAIMS, INDEMNIFIES, RELEASE FROM LIABILITY, SAVES HOLDS HARMLESS AND DEFENDS AND COVENANTS NOT TO SUE FIVE STAR DOG RESORT FACILITY, and their invitees, sponsors, advertisers, owners officers, directors, employees, volunteers, invitees’ agents, lessees, and any parties owning, controlling or having any interest in the property at which pet boarding or day stay is taking place, and all other representatives or agents (the “Releasees”) from and against ANY AND ALL INJURY, LIABILITY, CLAIMS, LITIGATION, ACTIONS, SUITS, COSTS, LOSSES, DAMAGES, EXPENSES R DEMANDS (including reasonable attorney’s fees) OF EVERY CHARACTER WHATSOEVER on account of rising out of, resulting from or relating in any way to any act or omission of the Releasees, including negligence, owner or pet’s participation in activities at the facility or otherwise. OWNER AGREES THAT THIS RELEASE SHALL BE BINDING ON THE OWNER AND OWNER’S SUCCESSORS, HEIRS, LEGAL REPRESENTATIVES AND ASSIGNS. OWNER ALSO EXPRESSLY AND FOREVER RELEASES FIVE STAR DOG RESORT AND RELEASES FROM ANY DUTY TO PROTECT OWNER OR OWNER’S PET(S) FROM INJURY OF ANY SUCH KIND, AND AGREES THAT EVEN IF FIVE STAR DOG RESORT CHOOSES TO IMPLEMENT SAFETY PRECAUTIONS, SUCH ACTIONS SHALL NOT ALTER THE AGREEMENT OR OWNER TO RELEASE FIVE STAR DOG RESORT AND RELEASEES FORM ANY DUTY TO PROTECT OWNER OR OWNER’S PET.

INITIALS:

Clear

Instruction 4

4. OWNER HAS READ AND FULLY UNDERSTANDS THIS AGREEMENT AND UNDERSTANDS THAT OWNER HAS GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAS SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE AND INTENDS IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT PERMITTED BY LAW AND AGREES THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID OR UNENFORCEABLE THAT THE REMAINDER SHALL REMAIN IN FULL FORCE AND EFFECT. OWNER AGREES THAT IT IS INTENDED THAT ALL TERMS OF THIS AGREEMENT CONTROL DESPITE ANY PARTICULAR STATUE OR LAW THAT WOULD OTHERWISE PROTECT OWNER OR OWNER’S PET(S).

INITIALS:

Clear

Instruction 5

5. This agreement and, if applicable, the Pet Medication Form, contains the entire agreement between facility and the owner. All terms and conditions of this agreement and Pet Medication Form shall be binding on the heirs, administrators, personal representatives and assignees of the owner. Any controversy, claim or dispute in any way arising out of this agreement or Pet Medication Form, or breach of this agreement or Pet Medication Form, or as a result of any claim or controversy involving alleged negligence by any party to this agreement or Pet Medication Form, interpretation or enforcement, shall first be mediated by the parties before an agreed upon mediator. In the event that such mediation fails to resolve such dispute it shall be submitted to binding arbitration and shall be settled in accordance with the rules of the American Arbitration Association. An arbitrator’s award may be entered as a judgment in any court having jurisdiction. The arbitrator shall, as part of the award, determine the prevailing party’s cost of arbitration and reasonable attorney’s fees of the prevailing party. The arbitrator(s) shall apply Georgia law to the merits of any dispute or claim, without reference to conflicts of law rules. Owner consents to the personal jurisdiction of the state and federal courts located in Georgia and agrees that such courts shall have the sole and exclusive jurisdiction for any action or proceeding arising from or relating to any arbitration in which the parties are participants. Owner has read and understands this clause which discusses mediation and arbitration. Owner understands that by signing this agreement.

OWNER WILL SUBMIT ANY CLAIMS ARISING OUT OF,OR RELATING TO, OR IN CONNECTION WITH THIS AGREEMENT, OR THE PET MEDICATION FORM FOR THE INTERPRETATION, VALIDITY, CONSTRUCTION, PERFORMANCE, BREACH, OR TERMINATION, TO MEDIATION AND IN THE EVENT OF NO RESOLUTION IN MEDIATION, TO BINDING ARBITRATION. THIS CLAUSE CONSTITUTES A WAIVER OF OWNER’S RIGHTS TO A JURY TRIAL AND JUDGE TRIAL FOR ALL DISPUTES RELATING TO ALL ASPECTS OF THE RELATIONSHIP BETWEEN FACILITY AND OWNER. IT IS EXPRESSLY AGREED THAT FACILITY’S LIABILITY SHALL NOT EXCEED THE LESSER OF THE CURRENT CHATTEL VALUE OF A PET OF THE SAME BREED OR $400.00.

INITIALS:

Clear

Instruction 6

6. PHOTO AND VIDEO RELEASE. Owner agrees that for promotional, advertising, or other purposes your pet(s) may be videotaped, photographed and/or recorded while pet is staying at facility. Facility shall have the exclusive ownership of all such tapings, photographs, or recordings, with the worldwide rights of an unlimited number of times in perpetuity, to copyright, use and license such property to others in any manner. Owner further agrees that pet(s) may be used in any and all media and in promotion, advertising, publicizing and exploitation of Five Star Dog Resort

Instruction 7

7. PERSONAL PROPERTY. Owner agrees that facility shall not be responsible or liable for any loss, stolen or damaged personal property. Owner also agrees that the pet’s collar maybe removed to prevent injury to any property, to other pets or humans. If the pet causes any damage to any person, any animal, the facility or equipment, owner agrees to be fully responsible for the full cost of any care, medical care, repair or replacement.

Instruction 8

8. DAY STAY REQUIREMENTS-NO LUNCH PROVIDED. Pets will not be fed lunch during day stay. If owner wants the pet to eat lunch, owner must bring a container of food marked with pet’s name and feeding instructions. Owner warrants that a pet participating in day stay is not aggressive. Owner understands that aggressive animals are not permitted to attend day stay and that if a pet exhibits aggressive or unacceptable behavior the pet may be separated from other day stay participants. Aggressive pets will not be permitted to attend day stay and such determination shall be made at the sole discretion of the facility. Pets attending day stay must be over the age of four months and have been spayed or neutered if over the age of six months.

Instruction 9

9. BOARDING REQUIREMENTS. A pet bath at an additional charge is required before the pet’s departure after two (2) or more nights’ stay. at the sole discretion of the facility. Additional fees are charged for a pet’s participation in playtime while boarding and for boarding aggressive pets.

Instruction 10

10. OTHER OBLIGATIONS. Owner warrants that the Pet is current on Rabies, Distemper and Bordetella vaccinations, is in good health and free of ticks and fleas, is not protective of objects or other animals or humans, meets all other municipal and state and county licensure and other requirements, and is at the facility with a quick release collar that contains an identification tag bearing the pet’s name and owner’s current contact information, as well as vaccination and immunization data. Owner will ensure that the pet will enter and exit facility on a leash.

Instruction 11

11. REFUSAL TO ADMIT PET FOR ANY REASON. Facility reserves the right to deny admittance to a pet for any reason at any time.

Instruction 12

12. COLLECTION OF FEES AND/OR CHARGES. Owner agrees to pay any reasonable attorney’s fees to collect any charges or fees.

Instruction 13

13. CANCELLATION POLICY. Owner will lose deposit if he/she fails to cancel reservation at least seventy-two (72) hours in advance from the actual boarding date. For all credit card refunds, you must present the credit card that was used and a form of identification to verify identity in person.

INITIALS:

Clear

Instruction 14

14. REFUNDS. No deposits will be refunded after thirty (30) days.

INITIALS:

Clear

Instruction 15

15. NO PET ABANDONMENT. No pets may be abandoned. Owner agrees that the pet will be picked up by the time the pet is scheduled to leave unless notification of changed plans is made and accepted by the facility. If owner has not picked up the pet as agreed, then the pet will be considered abandoned upon the third (3rd) day following failure to pick up and the facility will become the legal owner and guardian of the pet. The facility will, in its sole discretion, determine where and how to place the pet with the new owner. OWNER UNDERSTANDS THAT ABANDONMENT OF A PET MAY BE A CRIMINAL OR CIVIL VIOLATION. OWNER FULLY UNDERSTANDS AND AGREES THAT IF OWNER ABANDONS THE PET, OWNER MAY BE UNABLE TO RETRIEVE POSSESSION AND/OR OWNERSHIP OF THE PET AND WILL HAVE NO RECOURSE AGAINST THE FACILITY AS STATED IN THIS AGREEMENT.

Instruction 16

16. PAYMENT OF FEES. All charges incurred by owner and not previously paid shall be payable upon pick-up or delivery of the pet. In the event of a check being returned for insufficient funds or the denial of a credit card charge, the owner agrees to pay all additional expenses incurred by the facility to complete payment of the charges, plus an additional fee of $50.00 and, if applicable an additional check return fee of $50.00. All charges shall be paid before or upon pick-up of the pet. Facility is hereby granted and shall have a lien on any owner’s pet for any and all unpaid charges or fees due to facility.

Instruction 17

17. I HAVE READ AND FULLY UNDERSTAND THE TERMS AND CONDITIONS OF THIS AGREEMENT WHICH INCLUDES POLICIES, PROCEDURES, OWNER’S RELEASE WAIVER OF LIABILITY, AGREEMENT NOT TO SUE, AGREEMENT TO MEDIATE, ASSUMPTION OF THE RISK AND INDEMNITY AGREEMENT. Owner understands that owner has given up substantial rights by signing it and has signed it freely and voluntarily without any inducement, assurance or guarantee and tends it to be a complete and unconditional release of all liability to the greatest extent permitted by law and agrees that if any portion of this agreement or the Pet Medication Form is held to be invalid or unenforceable, that the remainder of this agreement and the Pet Medication Form control despite any particular statute or law that would otherwise protect owner or owner’s pet(s).

Instruction 18

18. I, the undersigned owner, acknowledge and agree that all the information provided in this Agreement is complete and accurate. Owner certifies to the accuracy of all information provided to facility in writing or orally. Owner further acknowledges and agrees that owner has read, understands and agrees to all terms and conditions in this Agreement. Owner executes this agreement and Pet Medication Form for owner’s pet, owner, owner’s heirs, successors, representatives, and assigns. Owner also represents, warrants and attests, that if owner is not the sole owner or representative of the pet, subject to this agreement and Pet Medication Form, that owner’s signature is sufficient to enter into this agreement and Pet Medication Form for and behalf of any other owner or representative. Owner specifically represents that owner has the legal right to enter into this agreement and Pet Medication Form.

Pet Owner’s Signature

Clear

Print Name

Date

Pet(s) Name(s)

Paragraph

FIVE STAR DOG RESORT PET MEDICATION FORM

NAME OF PET(S)

NAME OF MEDICATION

OWNER NAME:

DOSAGE INSTURCTIONS FOR ALL MEDICATIONS:

Owner's Name:

Paragraph

I AGREE THE INFORMATION CONTAINED IN THE PET SERVICE AGREEMENT AND ON THE PET MEDICATION FORM IS TRUE AND ACCURATE.

SIGNED, OWNER SIGNATURE:

Clear

DATE:

SUNDAY

Medication for Sunday

SUNDAY

DATE:

TIME:

MEDICATION:

INITIALS:

MONDAY

Medication for Monday

MONDAY

DATE:

TIME:

MEDICATION:

INITIALS:

TUESDAY

Medication for Tuesday

TUESDAY

DATE:

TIME:

MEDICATION:

INITIALS:

WEDNESDAY

Medication for Wednesday

WEDNESDAY

DATE:

TIME:

MEDICATION:

INITIALS:

THURSDAY

Medication for Thursday

THURSDAY

DATE:

TIME:

MEDICATION:

INITIALS:

FRIDAY

Medication for Friday

FRIDAY

DATE:

TIME:

MEDICATION:

INITIALS:

SATURDAY

Medication for Saturday

SATURDAY

DATE:

TIME:

MEDICATION:

INITIALS: