Step 1 of 4 25% ~Dog Grooming ONLY Application~ *Grooming NOT available on TUESDAYS and SUNDAYS Grooming hours: (10am-5pm) -> MONDAY, WEDNESDAY - FRIDAY (9am-5pm) -> SATURDAYS This is an application for NEW grooming clients ONLY. If you are interested in any other services, please fill out a New Client Application. This application is for Grooming ONLY.Owner Information Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell Phone*Work PhoneEmail* Employer Emergency Contact Information Emergency Contact* First Last Emergency Contact Phone*Emergency Contact Email Dog Information Pet Name*Gender*MaleFemaleBreed*Color/Markings*(please be detailed)Weight*(in pounds)Age of dog*(in years and months)Birth/Adoption Date Spayed/Neutered*YesNoIf "no", surgery is scheduled for Veterinary Information Primary Clinic*DoctorClinicAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Clinic PhoneClnic Website Grooming Information Has your dog ever been groomed before?*YesNoIf yes, date of last grooming appointment What service does your pet need?*Basic Groom (bath and brush, nail trim, ear cleaning, NO HAIRCUT)Full Groom (bath and brush, nail trim, ear cleaning, haircut of your choice)FFF Tidy (bath and brush, nail trim, ear cleaning, tidy of face, feet and sanitary area) Add-On Services/A La Carte Services - (*note additional fees) Nail grinding - $8 Tooth brushing - $10 De-shedding (for some coats) - starts at $12 Blueberry facial - $5 Paw Package (includes nail grind, moisturizing balm, and paw shave as needed) - starts at $15 Anal Gland Expression - $10 Additional Brush Out/Dematting - $10 per 15 minute session *Special grooming instructionsHow did you hear about us?*Google SearchFacebookAdvertisementExisting CustomerSpecial Event / FestivalFestYelpOnline CouponTrainerWalk-inOtherIf "other" or "referral", tell us more... Terms and Conditions I understand that before my dog(s) can play or board at Canine Crews, the following requirements must be met: My dog is not aggressive towards people or dogs and I give permission to the groomer to use proper restraints, safety harnesses, or muzzles, if needed.*I agreeMy dog’s complete veterinary inoculation records must be furnished to Canine Crews including rabies, Distemper Combo(DHLPP), bordatella and a negative fecal exam for parasites.*I agree Client Agreement and Release of Liability I hereby release Canine Crews, its agents, officers, sub-contractors, employees, animal owners, customers, and potential customers of Canine Crews from any and all liabilities, financial, and otherwise, for injuries to myself, my dog, 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 Canine Crews. I agree to assume all liabilities and responsibilities, financial and otherwise, for the behavior and health of my dog. In consideration of the services rendered by Canine Crews, I waive any and all claims, actions, or demands of any nature, foreseen or unforeseen, that I may have against Canine Crews relating to the care, control, health, and/or safety of my dog arising during pick-up, transport, drop-off, and stay at the facilities. I authorize Canine Crews to do whatever they deem necessary for the safety, health, and well-being of my dog while under the care of Canine Crews, including seeking professional veterinary treatment for my dog. Due to the many outstanding benefits of dog socialization and Canine Crews’ commitment to the safety and well-being of my dog, I agree that the benefits of dog socialization outweigh the risks. Furthermore, I request a socialized environment for my dog while under the care of Canine Crews. I understand that Canine Crews has the right to refuse service to me and/or my dog at any time for any reason. I understand that if my dog has a history of or repeatedly demonstrates aggression or biting of humans or animals, Canine Crews reserves the right to refuse service. I understand that all bites will be reported to the local authorities, as required by law. I hereby declare to Canine Crews that I am the legal owner of my dog; that my dog has not been exposed to distemper, rabies, or parvovirus within the past thirty (30) days, that my dog has been inoculated as indicated by records presented. I understand that videos and pictures will be taken of my dog(s) and used for marketing purposes.*I agree Payment Requirements Payments are due at the end of the day. I understand that the hours of operation at Canine Crews are 7 a.m.-7 p.m. Monday-Friday and 8 a.m.-6 p.m. Saturday and 9a.m.-11a.m. and 5 p.m.-7 p.m. on Sunday. A $5/hour late fee applies to be paid in cash upon arrival. If I have not picked up my dog by 1(one) hour after posted closing time, Canine Crews will board my dog overnight at my expense. Should this take place, I authorize in advance that Canine Crews will automatically charge my credit card a $15 late fee, in addition to boarding and daycare fees. If I purchase a half-day service and fail to pick up my dog after five (5) hours, I will be charged the full-day fee of $27. If I fail to pick up my dog by 7 p.m., I understand that a late fee and boarding fee will be assessed along with daycare fee. I authorize Canine Crews to charge my credit card for any outstanding balance on my account. I understand that I will be charged a $25 handling fee for returned checks. By signing below, I acknowledge that I have read this Grooming Agreement in its entirety and agree to the terms. This agreement shall be binding for a period of ten (10) years from the date of signature below.*I agreeYou agree to be automatically opted in to our email list for weekly/monthly newsletters with specials, coupons, events and other informational or educational Canine Crews news. You can easily opt-out at any time (unsubscribe button is sent with every email).*I agree*IMPORTANT! - You will receive a welcome email from Canine Crews shortly. - Please white-list our email (firstname.lastname@example.org) when it reaches your inbox. - This is where you will be receiving your confirmation emails for boarding, daycare, and grooming requests. FILLING OUT REQUEST FORMS (BOARDING/DAYCARE/GROOMING) DOES NOT SECURE YOUR SPOT. YOU MUST RECEIVE A CONFIRMATION EMAIL FROM OUR SYSTEM WHEN SENDING REQUESTS. CONFIRMATION EMAILS WILL BE SENT DURING NORMAL BUSINESS HOURS ONLY. Signature*CommentsThis field is for validation purposes and should be left unchanged. 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