Registration & Service Consent form


Personal information
Name *
Name
Address
Address
Primary *
Primary
The best number to reach you, cell or home
Work
Work
Additional Contact
Additional Contact
*If Applicable
Primary
Primary
Work
Work
Can this person make decisions regarding the health/treatment of your pet(s) in an emergency?
Additional Emergency Contact *
Additional Emergency Contact
*Aside from partner or spouse
Primary
Primary
Can this person make decisions regarding the health/treatment of your pet(s) in an emergency? *
Pet information
Dog or Cat *
Sex *
Is your pet spayed or neutered? *
All dogs in daycare and boarding 8 months and older must be spayed or neutered. For any questions please see our Q&A page.
Birthdate *
Birthdate
If you don't have an exact date, place insert an approximate date that will accurately reflect your pets age.
Second Pet Information
Dog or Cat
Sex
Is your pet spayed or neutered?
All dogs in daycare and boarding 8 months and older must be spayed or neutered. For any questions please see our Q&A page.
Birthdate
Birthdate
If you don't have an exact date, place insert an approximate date that will accurately reflect your pets age.
GENERAL LIABILITY RELEASE PLEASE READ THOROUGHLY
All information is very important
and that this pet(s) is/are in good health and are able to receive our services. I further certify that my dog(s) has/have not harmed or shown aggressive or threatening behavior towards any person or any other animal, ever. I have truthfully filled out appropriate DOG-A-HOLICS, Inc. registration forms for services I plan to use and I am agreeing to and understand the below information.
I do hereby waive and release DOG-A-HOLICS, Inc., its agents, officers, sub-contractors, employees, animal owners, customers, and potential customers of DOG-A-HOLICS, Inc. from any and all liabilities, financial, and otherwise, for injuries to myself, my pet or any other property of mine, which arise in any way from services and/or products provided by or as a consequence of my association with DOG-A-HOLICS, Inc
I agree to assume all liabilities and responsibilities, financial and otherwise, for the behavior and health of my pet. In consideration of the services rendered by DOG-A-HOLICS, Inc., I waive any and all claims, actions, or demands of any nature, foreseen or unforeseen, that I may have against DOG-A-HOLICS, Inc. relating to the care, control, health, and/or safety of my pet.
I do hereby waive and release DOG-A-HOLICS, Inc. from any and all liabilities of any nature for the actions of myself, my pet(s), or any other person who accompanies me, or holds a key to my home; except those arising from negligence or willful misconduct on the part of DOG-A-HOLICS.
I understand certain “activities” that my dog may participate in, including daycare, boarding, one-on-one play, walking, grooming, movement within and outside the facility and transportation to and from DOG-A-HOLICS Inc. involve risk and possibly injury and accept these risks. Further, I understand that I may be exposed to certain risks when bringing my dog to participate in activities at DOG-A-HOLICS, Inc. or when picking up my dog from participating in activities at DOG-A-HOLICS, Inc. Therefore, I hereby voluntarily release, forever discharge, and agree to hold harmless and indemnify DOG-A-HOLICS, Inc., its agents, successors, heirs from any and all liability, claims, demands, actions, or rights of action, which are related to, arise out of, or are in any way connected with my dog’s participation in activities at DOG-A-HOLICS, Inc., including those allegedly attributable to the negligent acts or omissions of DOG-A-HOLICS, Inc. or their staff.
If my dog is ill or injured while under the care of DOG-A-HOLICS, Inc., DOG-A-HOLICS, Inc. will make every reasonable effort to reach me pursuant to the contact information I have provided. However, if DOG-A-HOLICS, Inc. is unable to reach me, I authorize DOG-A-HOLICS, Inc., to do whatever they deem necessary for the safety, health, and well-being of my pet including seeking professional veterinary treatment for my dog via my veterinarian, Chicago Veterinarian Emergency Services. DOG-A-HOLICS, Inc. will not pay any portion of veterinary expenses associated with seeking medical care for my dog if so necessary.
I understand that DOG-A-HOLICS, Inc. has the right to refuse service to me and/or my pet at any time for any reason. I understand that if my pet has a history of, or repeatedly demonstrates aggression or biting of humans or animals, DOG-A- HOLICS, Inc. reserves the right to refuse service. I understand that all bites will be reported to the local authorities as required by law.
Once getting home, if I feel my pet was harmed in any way, I will report the injury claim to DOG-A-HOLICS Daycare within 24 hours after my dog’s stay. If I feel the injury was a result of being at DOG-A-HOLICS, I will bring my dog to DOG-A- HOLICS for examination. I understand that any injury claimed after 24 hours will not be considered to have been a result of my pets stay at Dog-A-HOLICS and I will not be monetarily compensated by DOG-A-HOLICS, Inc for any veterinary bills or refunded of services.
GROOMING - ADDITIONAL REQUESTS FOR CLIENTS:
BOARDING & DAYCARE - ADDITIONAL REQUESTS FOR CLIENTS:
If my dog causes injury to another animal while they are at day care, I assume financial responsibility for any medical care the injured animal needs.
Full payment for daycare services are due at time of enrollment or at time of services rendered, and may be made payable to DOG-A-HOLICS, Inc. I understand that enrollment in daycare at DOG-A-HOLICS is subscription based and will be charged on a monthly basis. I understand that changes and/or cancelations to daycare packages must be made prior to the last day of my billing cycle. I understand there are no refunds for packages. I further agree to pay for any additional services requested such as grooming, pick-up and/or drop-off service, etc. All services must be paid in full before dog will be released to client.
Full payment for daycare services are due at time of enrollment or at time of services rendered, and may be made payable to DOG-A-HOLICS, Inc. I understand that enrollment in daycare at DOG-A-HOLICS is subscription based and will be charged on a monthly basis. I understand that changes and/or cancelations to daycare packages must be made prior to the last day of my billing cycle. I understand there are no refunds for packages. I further agree to pay for any additional services requested such as grooming, pick-up and/or drop-off service, etc. All services must be paid in full before dog will be released to client.
ALL CLIENTS:
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REPRESENTATIONS ABOUT MY DOG
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Today's date
Today's date