New Customer Application Step 1 of 4 25% Owner Information Name* First Last Address* 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 Home Phone Cell Phone* Work Phone Email* Employer Spouse/Partner Spouse/Partner Name First Last Spouse/Partner Email Spouse/Partner Cell PhoneSpouse/Partner Work Phone Emergency Contact Information - (other than your spouse/partner) Emergency Contact* First Last Emergency Contact Phone*Emergency Contact Email Other People Authorized to Pick-up Your Dog Auth. pick-up First Last Auth. pickup phoneRelationship Dog Information Pet Name*Gender*MaleFemaleBreed*Color/Markings*(please be detailed)Weight*Age of dog*(in years and months)Birth/Adoption Date Spayed/Neutered*YesNoIf "no", surgery is scheduled for: My Dog's Brother or Sister (if applicable)* *if you have more than 2 dogs please see box at end of application. Pet NameGenderMaleFemaleBreedColor/MarkingsWeightAge of dog(in years and months)Birth/Adoption Date Spayed/NeuteredYesNoIf "no", surgery is scheduled for Veterinary Information Primary Clinic*Doctor Clinic 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 Clinic PhoneClnic Website Other Important Information My dog(s) has a pre-existing medical condition (i.e. injuries, scars, weak stomach):*YesNoIf yes, explain:My dog(s) is on medication:*YesNoIf yes, medication name:Condition/reason:Dosage (amount/frequency)Special Notes/Instructions:Is your dog allowed treats?*YesNomaybeAny allergies?Is your dog crate trained?*YesNo Dog Behavior InformationMy dog(s) attended obedience school:YesNoIf yes, where?Has your dog(s) been in a fight with another dog?*YesNoIf yes, when?Was medical treatment required for either animal?YesNoIf yes, what kind of treatment and where?How often does your dog interact with other animals? (dog parks, play dates, day care, daily walks):Why would you like to enroll your dog in a day care program? (energy outlet, long hours at work, socialization)Has your dog ever bitten a human?*YesNoIf yes, what kind of treatment was required?Does your dog(s) guard food or objects?*YesNoWhat brand/kind of food do you feed your dog(s)?* Information for additional dog(s):In which services are you interested? Daycare Boarding Grooming Walking Dog Bus Pet Sitting Training Bark Park Puppy Program How did you hear about us?*select oneReferralAdvertisementExisting CustomerSpecial Event / FestivalGoogle SearchYelpOnline CouponTrainerWalk-inotherIf "other" or "referral, tell us more... Terms and ConditionsI understand that before my dog(s) can play or board at Canine Crews, the following requirements must be met: My dog must pass a temperament test to ensure s/he is not aggressive toward people or other dogs.*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 agreeMy dog must be spayed or neutered unless younger than 6 months of age.*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 Daycare & Boarding 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 (email@example.com) when it reaches your inbox. - This is where you will be receiving all of 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*Additional NotesWant to schedule your trial day, already have some boarding needs?PhoneThis field is for validation purposes and should be left unchanged.