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Registration Form and Contract for Services

  

GUEST INFORMATION  (Add additional guests at the end of page)

Pet

NAME_______________________________________________________

 

BREED      ___________________________________________________

AGE_____________________

WEIGHT:____________________________

 

DESCRIPTION________________________________________________

 

MICROCHIP NUMBER_________________________________________

 

RABIES CERTIFICATE NUMBER_____________DATE:______ __________

 

BORDETELLA (Required)  DATE ADMINISTERED_____________________

 

KNOWN MEDICAL CONDITIONS, MEDICATIONS TO BE ADMINISTERED

__________________________________________________________________________________________

______________________________________________________________________________

Pet

NAME_______________________________________________________

 

BREED      ___________________________________________________

AGE_____________________

WEIGHT:____________________________

 

DESCRIPTION________________________________________________

 

MICROCHIP NUMBER_________________________________________

 

RABIES CERTIFICATE NUMBER_____________DATE:______ __________

 

BORDETELLA (Required)  DATE ADMINISTERED_____________________

 

KNOWN MEDICAL CONDITIONS, MEDICATIONS TO BE ADMINISTERED

____________________________________________________________________________________________________________________________________________________________________________

 

OWNER INFORMATION: 

NAME:      

(1)___________________________________________________

                   

(2)___________________________________________________

 

DL:  STATE______NUMBER________________EXP DATE____________

 

ADDRESS_______________________________________

 

PHONE___________________ALT PHONE_____________________

 

EMAIL_______________________________________________________

 

LOCAL EMERGENCY CONTACT PERSON_____________________________

 

ADDRESS_____________________________________________________

 

PHONE: ______________________ALT PHONE __ ___________________

 

MEDICAL INFORMATION  

VETERINARIAN:       

 

NAME______________________________________

 

ADDRESS________________________

 

PHONE_________________________

 

RABIES CERTIFICATE NUMBER_____________DATE:______ __________

 

BORDETELLA (Required)  DATE ADMINISTERED_____________________

 

KNOWN MEDICAL CONDITIONS, MEDICATIONS TO BE ADMINISTERED

____________________________________________________________________________________________________________________________________

BOARDING CONTRACT

Thank you for choosing Safe Haven Pet Care and Boarding.  We look forward to caring for your pet(s).   Please read and initial the following terms and conditions:

_____ I hereby authorize Safe Haven and its representatives to provide routine care for our pet(s);

 

_____For the safety of your pet, we require that your pet wear a collar (or harness) with a tag with owner information at all times;

 

_____Every attempt will be made by Safe Haven representatives to contact owner prior to obtaining veterinary care but in the event they cannot be contacted owner of the above pet(s) hereby give authorization to Linda Phipps;, or any authorized representative of Safe Haven to obtain emergency medical care at their discretion and as recommended by a licensed veterinarian and agree to be responsible for any and all expenses pursuant to such care.  In the event the veterinarian listed above cannot be contacted, Safe Haven may contact a veterinarian of their choosing to perform necessary emergent care.  Any and all expenses incurred in the treatment of your pet will be incurred by the pet owner and will be payable prior to release of the pet;

 

_____Payment for boarding services will be paid in full, in advance of boarding.  Payment will be in the form of cash, check or PayPal.  Credit Cards are not accepted.  Kennel space has been reserved for your pet(s) for the period of time contracted therefore, upon cancellation or early return, payment is non-refundable.  A non-refundable reservation fee of $25.00 per kennel will be paid upon reservation and will be applied to payment due at commencement of boarding.  Make checks payable to LINDA PHIPPS.  A $25.00 service fee will be charged for returned checks;

 

_____I agree to pick up pet(s) on the date specified in this agreement.  Failure to do so within ten (10) days following the specified date will be consider abandonment of the animal(s) and they will become the property of Safe Haven unless other arrangement are made to extend the return date with full payment for additional dates made in advance.  No one other than the owner may pick up the pet(s) unless designated in advance;

 

_____Hold Harmless and Attorney Fees and Costs

In consideration of my/our receiving from Safe Haven Boarding Facility stated above, by signature below, I agree to the following:

The undersigned understands that he/she must abide by the terms of this agreement and do hereby release and hold harmless Safe Haven, its members, officers, and its volunteers from any claims, damages or actions incurred as a result of this contract for services.  I/we understand that this contract is binding in the United State of America and that compliance with any of the terms of this agreement, including failure to pay or problems encountered in the collection of fees may result in legal action and seizure of the animal;

Safe Haven will not be held responsible for failure to comply with terms of contract due to Natural Disaster, Acts of God or other circumstances beyond our control.

DISCLAIMER:  SAFE HAVEN reserves the right to limit or refuse services at their discretion.

Signature of Owner(s) _____________________________________________

 

Signature of Safe Haven Representative________________________________

 

Date______________________________________________

 

Safe Haven Pet Care and Boarding

29 Oakridge Court, McLoud, OK 74851          

405-824-6530     LPhipps321@aol.com

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