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This is the online version of our Dog Daycare & Boarding Application. Please completely and accurately fill out the following information. The DOG MEDICAL POWER OF ATTORNEY/RELEASE AND INDEMNITY AGREEMENT listed below will need to be signed upon your visit to our office.
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| CUSTOMER INFORMATION |
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| Name: |
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Day Phone: |
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| Address: |
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Eve Phone: |
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Cell Phone: |
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| City: |
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How did you hear of us? |
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| State: |
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| Zip: |
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| Email Address: |
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| EMERGENCY CONTACT INFORMATION |
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| Name: |
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Phone: |
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| Other people authorized to pick up your dog: |
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| DOG INFORMATION |
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| Dog's Name: |
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Breed: |
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| DOB: |
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| Sex: |
Male
Female
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Spayed:
Neutered:
Under 6 months:
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| Dog's Name: |
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Breed: |
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| DOB: |
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| Sex: |
Male
Female
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Spayed:
Neutered:
Under 6 months:
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| VETERINARIAN AND HEALTH INFORMATION |
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| Clinic Name: |
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Phone: |
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| Any chronic health conditions, major surgeries or food allergies? |
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| If your dog becomes ill or injured where would you like them taken? |
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On-call Vet:
Closes Vet:
My Vet:
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| PERSONALITY PROFILE |
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| Does your dog have issues with children, cats, loud noises, etc? |
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| Is your dog crate/kennel trained? |
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| How does your dog respond to brushing? Any sensitive areas? |
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| Has your dog been to another Daycare or Off-leash Dog Park? Where? |
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| Does your dog Jump/Climb fences?
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| What height?
(Note-DogTown fences are 6 ft high)
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| Any additional information we should know to best care for your dog? |
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Please call us at (503) 669-8081 to set up an evaluation time. Please inform us that this application was filled out online for quicker service. An evaluation may be waived for current DogTown students. Copies of the required vaccinations (DHLPP, Bordetella, and Rabies) must be mailed to: DogTown, 335 NE 8th Street, Gresham, OR 97030 or faxed to 503-669-8050. Dogs must also be current on flea treatment. There is a $15 fee for flea applications given, if necessary. Dogs over the age of six months must be spayed or neutered.
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| DOG MEDICAL POWER OF ATTORNEY/RELEASE AND INDEMNITY AGREEMENT |
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I understand that DogTown frequently photographs dogs and people having fun in our facility and at off-site activities. I agree that some of these pictures may be used in DogTown’s promotional materials or website.
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Yes
or No
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I understand that there is a 25% non-refundable deposit required for Boarding, due at time of reservation.
I understand that there is a $25 fee for any returned checks.
I understand that if my dog(s) is/are left at DogTown for more than 3 days after their scheduled pickup date and DogTown is unable to contact me, my dog(s) may be considered abandoned. DogTown reserves the right to seek a new home for an abandoned dog(s) and no compensation will be made to the owner.
I understand that DogTown reserves the right to permanently remove any dog from Daycare at any time.
I understand and agree that there are risks, in addition to benefits of Dog Daycare. I herby irrevocably release, waive and indemnify DogTown, LLC, its owners, staff, property owner and affiliates from any and all claims for liability on account of any injury, loss, damage, infection, and diseases to my dog(s), up to and including, death.
I, the owner of the dog(s) named herein, herby designate DogTown, LLC and its officers to act as my attorney-in-fact and to act in my name for the emergency medical benefit of my dog(s). By executing this document, it is my intention that DogTown shall have authority to make all emergency health decisions for my dog(s), including, but not limited to the following: to employ and discharge medical personnel; to execute documents; to provide written consent for treatment; to obtain and administer prescribed medications; and to incur reasonable and necessary expenses in carrying out the powers and duties under this document. I agree to reimburse DogTown for any and all expenses incurred at their discretion. I further agree to indemnify and hold harmless DogTown from any and all liabilities for acts done in good faith. I further state that should my dog pass away during my absence, I direct that a veterinarian will be called upon to safe keep my dog until my return.
I would like to be notified immediately upon the injury, loss or death of my dog.
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Yes
or No
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By clicking the 'Submit' button below, I am accepting all terms and conditions of this agreement and I agree to abide by those Rules and Regulations.
View Rules & Regulations
I also understand that this agreement contains a Medical Power of Attorney, a Release of Liability, an Indemnity Agreement for services between DogTown and myself. If any part of this agreement is deemed unenforceable, all remaining parts shall be given full affect to the extent possible. If there is a dispute between the parties relating to this agreement, the party substantially prevailing shall be entitled to recover all costs and expenses of any subsequent proceedings, including the attorney and/or arbitration fees incurred therein. This agreement contains the complete understanding of the parties with respect to the subject matter and supersedes all prior oral and written presentations and understandings. This agreement may be modified only in writing and signed by all parties.
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