1. pets
2. dogs

HOLD HARMLESS / RELEASE OF LIABILITY AGREEMENT
Poochie’s Pampered Pups, its owner, employees, representatives or any other person affiliated with the
company shall hereinafter be referred to as "Poochie’s Pampered Pups"
By signing this form, you or your representative ____________________________________ (your name here)
shall hereinafter be referred to as "CLIENT" and agree not to hold Poochie’s Pampered Pups liable or sue for
any injuries and/or death to my dogs or myself while in the care of or the facility of Poochie’s Pampered Pups.
Although we screen the dogs for temperament, we watch the dogs carefully and do not accept aggressive
dogs, day care can be hazardous due to dogs playing together. They can get rambunctious at times and we
cannot be held responsible for injuries/death that may occur in and out of the day care including the
transportation of animals.
In my absence, if my pet becomes ill or injured or in need of veterinary care, Poochie’s Pampered Pups has
my permission to consult with or take my pet to a vet of their choice. I understand that reasonable efforts will
be made to contact myself and/or anyone listed as emergency contact and Poochie’s Pampered Pups will
make every reasonable effort to take my pet to my veterinarian, however, in case of emergency, I
authorize Poochie’s Pampered Pups to make decisions on my pets care in my absence. I understand that I am
responsible for any costs, including transportation associated with such incident.
I agree not to hold Poochie’s Pampered Pups responsible for the loss of my dog in the unlikely event (s)he
jumps the fence or escapes during transport or while in our care.
I hereby declare that my pet has never shown aggression, bitten, injured or killed another person or dog. If my
dog does, I agree to pay all bills associated with the incident.
I hereby declare that my pet has not been exposed to any communicable diseases within the last 30 days and
is fully vaccinated (Rabies, Bordetella, Distemper) and is on Flea Preventative.
I understand that Poochie’s Pampered Pups will not be responsible for lost, dirty, damaged or destroyed
belongings left in Poochie’s Pampered Pups care.
By signing this form, you acknowledge that you understand and accept the terms and conditions set forth by
this agreement.
I have read, understand, and have no questions about the above content.
Your Printed Name: _____________________________________________________________
Signature: _____________________________________________________________________
Phone Number: ___________________________________
Date: _______________________________
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Client Release and Information Sheet
Name: ______________________________________________________________________________
Address: ____________________________________________________________________________
City: ___________________________________ ST: __________ Zip: ____________________________
Home Phone: _________________ Cell Phone: ___________________ Work Phone: _______________
Email: _______________________________________________________________________________
How did you hear about us? _____________________________________________________________
Pet Information:
Pet Name: ________________ Sex: ___ Breed: __________________ Age/Birthday: ___________Spayed/Neuter?: ____
Pet Name: ________________ Sex: ___ Breed: __________________ Age/Birthday: ___________Spayed/Neuter?: ____
Pet Name: ________________ Sex: ___ Breed: ___________________ Age/Birthday: ___________Spayed/Neuter? ____
EMERGENCY CONTACT: (this person has permission to make any and all decisions on my behalf in the event I am not
available and this person has permission to pick up my pet at any time.)
Name: ______________________________________________________________________________
Phone: _________________________________ Email: _______________________________________
Vet Information:
Name: _____________________________________________________________________________
Phone: _____________________________________________________________________________
Medical History, Medications, and/or Special instructions: _____________________________
______________________________________________________________________________
______________________________________________________________________________
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