Information Release Form

Pet Owners Name: *

Date: *

Address: *

City: *

Zip: *

Primary Phone Number: *

Secondary Phone Number:

Emergency Contact: *

Emergency Number: *

Email Address: *

Dog’s Name: *

Breed: *

DOB: *

Age: *

Sex: *
MF

Neutered/Spayed: *
YesNo

Veterinarian Hospital: *

Veterinarian Phone Number: *

List any known allergies: *

Existing health concerns & physical limitations: *

Release Statement: *
Daycare Dogs are involved in very active play throughout the day. This includes running, climbing on and jumping off playground equipment, and rough housing with their canine buddies. Despite our best efforts, accidents may and will occasionally occur, and injury may result. I understand and accept the risk and agree that Barks on the Boulevard, it’s employees, officers, and owners will not be held responsible for any injury. I authorize Barks on the Boulevard to seek emergency treatment for any injury deemed an emergency but agree that if they are unsuccessful in contacting me; emergency care will not be delayed. All cost for veterinary care from injuries or illness is the (pet owner’s) responsibility.

Pet Owner’s Signature: *

Date: *

Has your pet ever attended another dog daycare program? *
YesNo

What other experiences has your dog had with other dogs?
Dog ParkTraining ClassesDog ShowsOther

KNOWLEDGE is power! Please advise us of any behaviors your dog has which would ensure their experience in our daycare program be a positive one. Example: fence climbing, thunderstorm phobia/fears, food aggression/resource guarding, male or female aggression? *

What are your expectations of our Doggies Daycare Program? *

What is your dog's favorite toy? *

What is your dog's favorite thing to do? *

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