Doggy Daycare Application - Amity Woods Animal Hospital & Pet Lodge, Veterinarian in Kansas City, MO

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Owner Information

First Name

Last Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Secondary Phone

Email*

Date*

Dog Information

Name*

Breed*

Birthday

Age

Gender*

Male
Female

Spay/Neuter*

Spayed
Neutered

Additional Information

How long have you owned your dog?

Where did you get your dog?

Does your dog have any medical conditions such as allergies, skin problems, heart conditions, loss of hearing or eyesight?

Yes
No

Does your pet have any sensitive areas on their body?*

Yes
No

Please check all of the following your dog does not like:

Is your dog protective of any of the following?

Family Members
Other Pets (Siblings)
Food Bowl
House/Yard

Concent*

Shoal Creek Animal Hospital and Lodge at Shoal Creek Animal Hospital agree to exercise due diligence and reasonable care and to keep the premises sanitary and properly enclosed. Shoal Creek is dedicated to providing a safe and fun environment for you, and we will take reasonable and necessary precautions to ensure the security of our guests - both human and canine.

I understand and agree that in admitting my dog(s) to Shoal Creek, the staff is relying on my representation that my pet is in good health and has not harmed or shown aggressive or threatening behavior towards any person or dog. I am responsible for informing the staff of any changes before my pet attends daycare. I understand that all animals over the age of 6 months must be spayed or neutered.

I understand that I am responsible for any harm caused by my dog(s) while he/ she is attending daycare. Shoal Creek assumes no liability for loss or damage from disease, sickness, death, running away, theft, fire, injury to persons, other pets or property by your dog(s) or other unavoidable causes, due diligence and care having been exercised. I hereby release Shoal Creek of any liability and I further agree to indemnify and hold them harmless against any and all claims arising from my pet's attendance and participation at Shoal Creek, including but not limited to, all costs, attorneys fees, expenses and liabilities in connection therewith.

I understand that they daycare area has a web cam installed and is accessible on the internet at www.shoalcreekanimalhospital.com.

I certify that I have read and understand the policies of Shoal Creek as set forth on the preceding pages and that I have read and understand the conditions and statements of the agreement.

NOTICE: There is an inherent risk of a fight, resulting in possible injury to your dog, when there is a commingling of dogs from different backgrounds, with different temperaments and owned by different individuals. There is also an inherent risk of disease transmission when there is a commingling of dogs from different backgrounds with different medical and treatment histories and owned by different individuals

I agree to all of the terms and conditions stated above.