Application
Hope’s Boarding Camp &
Doggie DayCare LLC
HBCDDC Camper Application –
6 Pages Total
Please fill out an
application for each Camper
Guardian/Owner Name _______________________________ Additional Owner
____________________________
Address
_______________________________________ City __________________ State ___
ZIP ______________
Mailing
Address if Different___________________________ City
_____________________State___ ZIP_________
E-Mail
Address
_________________________________________________________________________________
Home
Phone # (___) ________________ Work # (___) __________________ Cell #
(_____) __________________
SMS:
Yes/ No
Permission to post your pet on Social Media i.e., Face book/ Instagram :
Yes/ No
Additional Phone #____________________ Drivers License or Social Security
##___________________________
LOCAL / EMERGENCY CONTACT:
(someone to call if your Camper
is exhibiting excessive, unruly behavior or in case of a Hope’s staff member
emergency), __
___________________________________________________________
Relationship
___________________ Phone
# (___) ___________________
Email ________________________
_____________________________________________________________________________________________
Employer_______________________________________
How did
you hear about Hope’s Boarding Camp? __ Newspaper __ Car decal __
Dexknows.com __ Google
__
YellowPages.com __ other search engine __ Referral from
_______________________
Pet Information
(Canine/Feline) Breed____________________________________ Name
______________________________
Description (Colors)
__________________________________________ Female ___Male____
___Yes
or ___No
my Camper is/isn’t
___ Spayed ___ Neutered
Weight
_______ lbs
Birth Date ________
Adoption / Anniversary Date ___________
Persons
Authorized to Drop Off and/or Pick-Up My Camper
_____________________________________________________________________________________________
Can
your Camper(s) have special treats provided by Hope’s Boarding Camp?
___Yes ___No
Have
you ever used Doggy Day/Overnight Boarding services?
___Yes ___No
If yes,
please list:
_______________________________________________________________________________
What
are your primary reasons for bringing your Camper to Hope’s Boarding Camp &
Doggie DayCare LLC?
___ Vacation ___ Travel extensively
___ Work long hours ___ Don’t
like to leave alone all day
CAMPER BEHAVIOR QUESTIONS:
Please answer the following questions as accurately as
possible.
How
long have you had your pet?
__________________________________________________________________
Where
did you get your camper?
__________________________________________________________________
Is
there any PERSON, type of DOG, or SITUATION your camper seems to have a
problem with? ___Yes
___No
Please
describe:
________________________________________________________________________________
Has
your Camper ever growled at or bit another PERSON, Dog, or Cat?
___Yes ___No
If yes,
what were the circumstances?
_____________________________________________________________________________________________
Is your
camper Coprophagic
(poop eater)? ___Yes
___ No
Is your
camper a Digger? ___ Yes
___ No
Is your camper an escape artist? ___Yes ___No
Is your
camper an Excessive Barker? ___
Yes ___ No
Can you take a food item away from
your dog without him growling?
___ Yes ___ No
Does
your camper have Allergies? ___ Yes
___ No
If Yes,
Please List:
_______________________________________________________________________________
Has
your camper ever jumped a fence or barrier?
___Yes ___No
Please
describe:
________________________________________________________________________________
Is your
camper house-trained? ___ Yes
___ No
Does
your camper have separation anxiety?
___ Yes ___ No
Is your
camper toy possessive?
___Yes ___ No
Are
there any areas on your camper’s body where they DO NOT like to be touched
by humans? ___ Yes
___ No
If yes,
which areas?
_____________________________________________________________________________________________
Are
there any restrictions that should be placed on your camper’s activities?
___ Yes ___ No
If yes,
what activities?
_____________________________________________________________________________________________
What
else should we know about our future Canine Camper?
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
FEEDINGS:
Client Provided – Brand
Name _______________________________________________________________
Morning
Quantity ________________________
Special Instructions ______________________________________
Afternoon Quantity ______________________
Special Instructions ______________________________________
Evening
Quantity ________________________
Special Instructions ______________________________________
MEDICATIONS:
Please list all
medications.
Medication __________________ Morning _______ Afternoon _______ Evening
_______ Quantity/Dose _______
Medication __________________ Morning _______ Afternoon _______ Evening
_______ Quantity/Dose _______
Medication __________________ Morning _______ Afternoon _______ Evening
_______ Quantity/Dose _______
Veterinarian Hospital
____________________________________________________________________________
Contact
Name ______________________________________________ Phone # (______)
____________________
Address ___________________________________________ City
_____________________ State ___ Zip_______
VACCINATIONS: Guardian/Owner is required to
provide veterinary proof of current Rabies, Distemper, Parvo
and Bordetella vaccinations. All Pets
must have a Flea and Tick preventive upon entry (Please Do Not Use the Hartz
Nor the Walmart Brands)
PAYMENT METHOD
FOR Day and Overnight Camp Fees we accept credit, debit, cash and honorable
checks (from a local bank, with DL#, and picture id, payable to Hope’s
Boarding Camp and Doggie DayCare).
I, the
undersigned, hereby acknowledge and agree all the information provided in
this Camper Application is complete and accurate to the best of my
knowledge.
I
further acknowledge and agree that I have read, understand and agree to all
terms and conditions contained in the Camp Policies, Procedures, and Waiver
of Liability, Assumption of Risk and Indemnification Agreement (the
Agreement), as they may be amended from time to time, which are attached and
fully incorporated into this application.
I hereby execute the Agreement for my dog, myself and my heirs,
successors, representatives and assigns.
I
further attest that I am owner or representative.
Guardian’s Signature_____________________________________________ Date _______________
Printed
Name____________________________________________________
Date _______________
Hope’s
Boarding Camp and Doggie DayCare LCC accepted this application _____ of
____________, 20 _____
__________________________
Day
Month
Year
Hope’s
Boarding Camp
CAMP POLICIES, PROCEDURES, WAIVER OF
LIABILITY, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT
In consideration for my
Camper to attend Hope’s Boarding Camp and Doggie DayCare, LLC (herein after
“Hope’s Boarding Camp” or “Camp”) for day and overnight boarding
(herein after “Camper”).
I make the following representations and agree to all of the following
policies, procedures, terms and conditions:
1.
CAMPER Requirements:
My Camper meets the following Camper requirements he/she: has
successfully completed Canine Camper Application; is four (4) months of age
or greater, is current on his/her Rabies, Distemper and Bordetella
vaccinations; is in good general health and free of ticks and fleas; is not
aggressive or protective of toys, meets all other municipal or state
licensure and other requirements; is attending Hope’s Boarding Camp with a
quick release collar, that contains an identification tag bearing my
Camper’s name and guardian or owner’s current contact information.
I have completed the Camper Application and have paid Hope’s Boarding
Camp in advance with credit, debit, an honorable check or cash.
My Camper will enter and exit Hope’s Boarding Camp facility with a
leash.
2.
CAMPER Food:
I understand I must bring my dog’s food in a sealed container (no plastic
bags, i.e. such as a trash bag, etc.) marked with My Camper’s name and
feeding instructions.
Hope’s Boarding Camp will feed the campers with the food brought by the
guardians according to the instructions provided in the Camper Application.
Unless campers are a family, they will be separate from all other
campers while eating.
3.
PERSONAL Property:
I agree that Hope’s Boarding Camp shall not be responsible or liable
for any lost, stolen or damaged personal property belonging either to my
Camper or me. I also understand
and agree that my Camper’s collar may be removed in the play area to prevent
injury to my Camper. If my
Camper causes any damage to Hope’s Boarding Camp facilities or equipment, I
agree to be fully responsible for the full cost of any repair or
replacement.
4.
CAMPER Fees:
I agree to pay for all camp fees, services and products, in advance
by credit, debit, cash or honorable check at the time I drop off my Camper,
or if additional services are after the fact.
I give my express permission for Hope’s Boarding Camp to charge me
the additional fees at the time of pick up for any unpaid camp fees,
services or products. I further
agree to pay the cost of any checks returned or challenges for any reason.
5.
REFUNDS:
I understand that overpayment will not be refunded (i.e. for
unscheduled shortened stay or services not rendered), but rather applied as
credit to my account and must be used within that calendar year.
6.
LATE fees and charges:
Hope’s Boarding Camp is closed
during major holidays, and after 5:00 PM on Monday – Sunday. If your
Overnight or DayCare Camper cannot be picked up during regular business
hours, they must be picked up the following business day, and the overnight
fee will be charged accordingly.
7.
CANCELLATION Policy:
For non-holidays, I understand that I will be charged for a full
night boarding fee if I do not cancel twenty four (72) hours in advance of
my reservation. For major
holidays, I understand I will be charged a non-refundable cancellation fee
of $50 if I cancel my reservation, regardless of advance notice.
8. AGGRESSIVE Campers: Although Hope’s Boarding Camp loves all dogs, I understand aggressive campers are not permitted to attend Hope’s Boarding Camp as Campers and if my Camper acts aggressively or exhibits unacceptable behavior he/she may be separated from the other Campers, however aggressive dogs may be asked not to return to the Hope’s Board Camp. Such determinations shall be made at the sole discretion of Hope’s Boarding Camp.
9.
ABANDONED Campers:
Hope’s Boarding Camp is a place where all Campers are loved and can romp
and play. No Camper may be
abandoned at the Hope’s Boarding Camp.
I agree that I will not neglect to pick up my Camper from Camp by the
time he/she is scheduled to leave without providing notification.
Any Camper that is left at the Hope’s Boarding Camp without any
contact, instruction, or notification from me, of the ability, willingness
or plans to pick him/her up by myself or my personal representative or agent
will be considered abandoned upon the seventh day or such notification
failure.
I understand that if a representative or agent will be considered
abandoned upon the seventh day of such notification failure.
I understand if I abandon my Camper at Hope’s Boarding Camp, HBC
will, by default, become the legal owner and guardian of the Camper.
HBC will, in its sole discretion, determine whether to try to re-home
and adopt the Camper from the Hope’s Boarding Camp location at which he/she
was abandoned or will relinquish the Camper to an unrelated shelter of its
choice.
I FULLY UNDERSTAND AND AGREE THAT IF
I ABANDON MY CAMPER AT Hope’s Boarding camp, I MAY BE UNABLE TO RETRIEVE
POSSESSION OF MY CAMPER AND WILL HAVE NO RECOURSE AGAINST Hope’s Boarding
Camp AS PROVIDED FOR BELOW.
10.
DUTY To Disclose:
I
have disclosed any and all medical or other conditions, including but not
limited to personality concerns or behaviors that may affect, limit or
prevent my Camper’s ability to participate in play time or otherwise attend
Hope’s Boarding Camp as a Camper.
11.
VETERINARIAN Liability and Care:
I agree to allow Hope’s Boarding Camp to obtain medical treatment for
my Camper, if, in its sole discretion it appears that, he/she is ill,
injured or exhibits any other behavior that would reasonably suggest that my
Camper may need medical treatment.
I Agree That I Am Fully Responsible For The Cost Of Any Such Medical
Treatment, And For The Cost Of Any Transportation For The Purposes Of Such
Treatment, Provided To My Camper.
12.
WAIVER, Release and Indemnification:
I HEARBY EXPRESSLY AND
FOREVER GENERALLY WAIVE, DISCHARGE CLAIMS, INDEMNIFY, RELEASE FROM
LIABILITY, SAVE, HOLD HARMLESS AND DEFEND AND CONVENANT NOT TO USE Hope’s
Board Camp, and their invitees, sponsors, advertisers, owners, officers,
directors, employees, volunteers invitees, agents, leasers, and any parties
owning, controlling or having any interest in the property at which the
event is taking place, and all other representatives or agents (the
“Releasees”) from and against
ANY AND ALL INJURY, Liability,
claims, litigation, actions, suits, costs, losses, damages, expenses or
Demands (including reasonable attorney’s fees) OF EVERY CHARACTER WHATSOEVER
on account of, arising
out of resulting from or relating in any way to (i) any act or omission of
the Releasees, including negligence, and (ii) my or my Camper’s
participation in activities at Hope’s Boarding Camp, or otherwise.
I FURTHER AGREE TO INDEMNIFY, SAVE AND HOLD HARMLESS the Releasees
from any claims, litigation, actions, suits, damages, costs, attorney’s
fees, losses or injuries as the result of any such claim.
I AGREE THAT THIS RELEASE SHALL BE BINDING ME AND MY SUCCESSORS,
HEIRS, LEGAL REPRESENTATIVES AND ASSIGNS.
I ALSO EXPRESSLY AND FOREVER RELEASE Hope’s Boarding Camp FROM DUTY
TO PROTECT ME OR MY DOG(S) FROM INURY OF ANY KIND, AND AGREE THAT EVEN IF
Hope’s Boarding Camp CHOOSE TO IMPLEMENT SAFETY PRECAUTIONS, SUCH ACTIONS
SHALL NOT ALTER THE FACT THAT I HAVE RELEASED Hope’s Boarding Camp FROM ANY
DUTY TO PROTECT ME OR MY DOG(S).
I HAVE READ AND FULLY UNDERSTAND THE TERMS OF THE CAMP POLICIES, PROCEDURES
AND, WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT (THE
“AGREEMENT”) AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY
SIGNING IT AND HAVE SIGNED IT FREEELY AND VOLUNTARILY WITHOUT
ANY INDUCEMENT, ASSURANCE OR GUARANTEE AND INTEND IT TO BE A COMPLETE
AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT PERMITTED
BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID
OR UNENFOREABLE, THAT THE REMAINDER OF THIS AGREEMENT SHALL REMAIN IN FULL
OFRCE AND EFFECT. I AGREE THAT
IT IS INTENDED THAT ALL TERMS OF THIS AGREEMENT CONTROL DESPITE ANY
PARTICULAR STATUTE OR LAW THAT WOULD OTHERWISE PROTECT ME OR MY DOG(S).
13.
COLLECTIONS:
I / We understand and agree
to pay court costs, attorney fees and a 50% (Fifty Percent) collection
agency fee on any outstanding balances over (Thirty) 30 days past due.
I / We also agree to pay 2% interest per month on any outstanding
balances over (30) days past due.
