New Client Form

(Please Print this form and bring with you for faster checkin time)

Your Name_____________________________________________ Spouse___________________

Address_________________________________________________________________________

City_______________________________________________State_________Zip_____________

Home Phone _____-_______-________ Work _____-_______-_______ Cell _____-______-______

Emergency Phone _____-______-________ e-mail_____________________________________

Veterinarian___________________________________ Vet’s Phone ________________________

Proof of Vaccinations yes_____no______If no, please call your Veterinarian and authorize their release or have them faxed to us at 903-597-4459

How did you hear about us? _______________________________________________________

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Pet 1 - Pets Name______________________  Breed ________________________________________

Birthdate:______________  If not known, his/her approximate age: ______  Color: ______________

Please Circle below the ones that apply to this pet:

Dog    Cat ------ Male   Female ------ Spayed   Neutered    Not Fixed ------ 

Has this pet ever bitten anyone? _______  Is this pet afraid of storms? ________

Does this pet have special needs/issues?  If yes, please explain: _____________________________

_________________________________________________________________________________

_________________________________________________________________________________

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Pet 2 - Pets Name______________________  Breed ________________________________________

Birthdate:______________  If not known, his/her approximate age: ______  Color: ______________

Please Circle below the ones that apply to this pet:

Dog    Cat ------ Male   Female ------ Spayed   Neutered    Not Fixed ------

Has this pet ever bitten anyone? _______  Is this pet afraid of storms? ________

Does this pet have special needs/issues?  If yes, please explain: _____________________________

_________________________________________________________________________________

_________________________________________________________________________________

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Pet 3 - Pets Name______________________  Breed ________________________________________

Birthdate:______________  If not known, his/her approximate age: ______  Color: ______________

Please Circle below the ones that apply to this pet:

Dog    Cat ------ Male   Female ------ Spayed   Neutered    Not Fixed ------

Has this pet ever bitten anyone? _______  Is this pet afraid of storms? ________

Does this pet have special needs/issues?  If yes, please explain: _____________________________

_________________________________________________________________________________

_________________________________________________________________________________

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Pet 4 - Pets Name______________________  Breed ________________________________________

Birthdate:______________  If not known, his/her approximate age: ______  Color: ______________

Please Circle below the ones that apply to this pet:

Dog    Cat ------ Male   Female ------ Spayed   Neutered    Not Fixed ------

Has this pet ever bitten anyone? _______  Is this pet afraid of storms? ________

Does this pet have special needs/issues?  If yes, please explain: _____________________________

_________________________________________________________________________________

_________________________________________________________________________________

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I, _______________________________________________, certify I am the owner/caretaker of the above mentioned pet(s).  I hereby grant permission to this boarding facility to act in my behalf and in my pets best interest by obtaining veterinarian care at my expense if deemed necessary for illness or injury. I further agree to pay for all veterinary and other necessary services incurred by and for my pet during its stay in this facility.

    This facility agrees to exercise all due and reasonable care to prevent injury or illness to my pet. However, in the event of illness or injury, the owners and employees of this facility shall not be held personally liable for such injury or illness.

    I agree to pay all costs for any property damage or personal injury caused by my pet during its stay. I agree to pay all charges on the day of pick-up of my pet and I understand that my pet may not leave the premises until all charges are paid in full. I understand that any animal left for ten days beyond the agreed date of pick -up may be sold or placed at the discretion of the facility owner.

Others authorized to pick up your pet(s):

(For the protection of your pet(s), NO OTHERS will be allowed, NO EXCEPTIONS)

Name/Phone:______________________________________________________________________

Name/Phone:______________________________________________________________________

Name/Phone:______________________________________________________________________

Check In/Out Policy:  Bark Avenue operates just like a human motel.  You are charged for the arrival date and are charged per day.  Check out time is 12:00 noon.  If your pet(s) are picked up before noon on the last day, there is no charge for that day. If pet(s) are picked up between 12:00 and 6:00pm, there will be a half days charge. 

Initials:__________

Owner/Caretakers Signature: ____________________________________Date:___________________

Pet Lodge & Grooming Salon