Owners Name by lonyoo



Owner’s Name: ________________________________________________________ ______________________________________________________________________ Address: City: ______________________________ State: __________ Zip: _______________ Primary Phone: ____________________ Check one: Home___ Mobile____ Other____ Alternate Phone: ____________________Check one: Home___ Mobile____ Other____ Business Phone: ___________________ Email ______________________________ Emergency Contact Name (if other than owner): _____________________________ Emergency Phone (if other than owner): ___________________________________ Dog’s Name: ___________________________ Breed: ______________ Weight: __________ Color: __________ Birth Date: ______________

DAYCARE AGREEMENT Please answer the following: �� Neutered Male �� Spayed Female ��Unaltered, under 8 months old (*dogs
over 8 months must be neutered or spayed)

Method of flea/tick control*: _______________________ (*must be treated for fleas/ticks) Does your dog have an I.D. tag? �� Yes Is your dog housebroken? �� Yes ��No (*dogs tags are recommended and should not be on choke/pinch collars) �� No ��No

Has your dog ever had kennel cough? ��Yes

Does your dog cough, sneeze, wheeze, or exhibit any asthmatic symptoms? �� Yes ��No Has your dog ever been boarded or attended doggie daycare? �� Yes ��No Has your dog ever bitten a person or another dog? �� Yes ��No Has your dog ever exhibited aggressive behavior towards people or other dogs? ��Yes ��No If yes, please explain: ______________________________________________________________________

Has your dog ever been bitten or attacked by another dog, or been abused? �� Yes ��No If yes, please explain: ______________________________________________________________________ Is your dog a jumper, climber, escape artist? ��Yes �� No If yes, please explain: ______________________________________________________________________ How did you hear about Sea Dog Inn? (Vet, friend, other) _______________________________________ Medical Emergency Information: Veterinarian’s Name/Clinic: _______________________________ Phone: _______________ City: ____________________ State: _________ Zip: ____________ Vaccinations: �� Rabies �� DH LP ��Parvo ��Bordetella (NOTE: We require a copy of vaccinations faxed or brought in on your dog’s first visit) Please describe any medical or physical problems (include seizures, separation anxiety, food allergies, etc): ____________________________________________________________________________

If in our judgment, your dog requires medical care, you agree to be solely responsible for the payment of all medical bills for your dog and you release Sea Dog Inn, its officers, directors, agents, and employees of and from any and all responsibility for, or claims, damages, or debts arising out of or related to such medical care, including but not limited to, transportation to/from the veterinarian clinic and choice of veterinarian or animal hospital. Initials: ____________

Authorized Pickup:
�� By checking here, you agree that you may verbally (by telephone) or in writing (by facsimile or otherwise) request that Sea Dog Inn release your dog to someone other than the person(s) listed above, and you release Sea Dog Inn of and from any and all responsibility for releasing your dog to any person Sea Dog Inn believes to be authorized by you. Please list any special instructions here: Sea Dog Inn will release your dog to the following person(s) with proper ID: __________________________________ Sea Dog Inn Policies: Sea Dog Inn reserves the right to immediately change your dog’s type of boarding/daycare if we believe it is necessary to protect the health and well being of your dog, other dogs, or a staff member. Sea Dog Inn cannot guarantee that toys, blankets, or bed will be kept in the same condition as brought in.. All dogs, over 8 months old, must be spayed or neutered, and must have all their vaccinations. ______________________________________

We recommend all dogs have an identification tag with either a phone number or address of the owner. The tag should include the dog’s name. All dogs must be on a leash when entering or leaving a building. There is a $4 per day charge when feeding your dog with “house” food. NOTE: We recommend that you bring in your own food since changing a dog’s food can cause a severe upset stomach. Dog owner understands the risks involved with communal boarding of dogs. Our boarding, daycare and grooming dogs play in the yard and inside with other dogs. Although we will offer reasonable care, the unpredictable personality of dogs can sometimes lead to injury. Dogs playing together in playgroups can sometimes result in injuries or spreading of such illnesses as Kennel Cough Dog owner understands that Sea Dog Inn’s liability, of any circumstance related to the dog, will not exceed the current chattel value of a dog of the same breed as the one in our care. You release, indemnify and hold Sea Dog Inn harmless from any and all manner of damages, claims, losses, liabilities, costs or expenses, causes of action or suits, whatsoever in law or equity (including, without limitation, attorney’s fees and related costs) arising out of or related to the services provided by Sea Dog Inn, except which may arise from the sole gross negligence or intentional and willful misconduct of Sea Dog Inn, including, without limitation: (i) any inaccuracy in any statement made by yourself or information provided by you to Sea Dog inn (ii) your dog, including but not limited to destruction of property, dog bites and transmission of disease, and (iii) any action by yourself which is in breach of the terms and conditions of this Agreement. Due to the communal nature of our playgroups, and for safety/liability concerns, Sea Dog Inn does not allow any aggressive dogs for boarding or daycare. Sea Dog Inn reserves the right, without notice, to adjust its fees for services. Please inquire at the front desk as to our current fees. Initials: ____________ If you have any questions or need clarification, please call the office at 281 554-2068. Owners Signature: _______________________________________ Date: ______________

COMPANY USE ONLY: Received by: Employee’s name: _______________________ Date: __________________ Shot Records Received: ��Yes �� No Appointment Scheduled: �� Yes ��No

SEA DOG INN, INC 310 ELLEN AVE LEAGUE CITY, TX 77573 PH 281 554-2068 FAX 281 332-5368 EMAIL: seadoginn@hotmail.com WEBSITE: www.seadoginn.com

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