For The Love Of Dog
Dog Day Camp & Boarding


Registration Form
Medical Release
Registration Form

 
2705 Kinney Road                 fortheloveofdog33@gmail.com
Coos Bay, OR 97420                 www.fortheloveofdog33.com
541-808-3108


Dog’s Name:  __________________________________________


Your Name:   ___________________________________

Address Street:  ________________________________

City, ST Zip:____________________________________

Cell/Primary Phone: _____________________________


Secondary Phone:  ______________________________


Emergency Contact (Name, Number, Relationship):

______________________________________________

 

Dog’s Sex:  

 

Breed:  _______________________________________

 

 

 


Birthdate (Approximate if you don’t know): ______________________

Veterinarian:  __________________________________

 
Vet’s Phone:   __________________________________

 

Has your dog been vaccinated for Rabies, Bordetella, Distemper, and Parvo?

   


Is your dog spayed or neutered? (Must be done by 6 months):

 
 

Does your dog have any medical conditions?

 

 
If yes, briefly explain:

 

 

 


Has your dog been around a large group of off-leash dogs before?

 

If yes, how did they behave?

 



 

Is there any situation in which your dog becomes aggressive?

 

If yes, briefly explain:







How long have you had your dog? ____________________


Is there anything we should know about your dog?

 




 


 
 

FOR THE LOVE OF DOG DAY CAMP AND BOARDING, LLC SERVICE AGREEMENT AND WAIVER OF LIABILITY:

Parties. For the Love of Dog Day Camp and Boarding, LLC (Company) and Customer (Customer), as listed on the registration form.

Agreement. The Parties agree as follows: Customer understands that Company will be providing the following services: Dog daycare and boarding. While Company will provide such services in a responsible, careful manner, Customer acknowledges that Company and its employees cannot be, and are not, liable in the unlikely event of injuries or damages.

Waiver of Liability: Customer hereby releases Company and its employees from any liability, whether arising from breach of contract, negligence, or otherwise, alleging injuries or damages of any kind, including but not limited to personal injury, pet injury, bodily injury, property damage, or property loss.

Limitation of Time for Commencement of Claims: Customer agrees that any claim against Company or its employees, including but not limited to claims of negligence or breach of contract, alleging injuries or damages of any kind, including but not limited to personal injury, pet injury, bodily injury, property damage, or property loss, shall be barred unless asserted by the commencement of an action in a court of law within one year after any such cause of action arises.

Limitation of Damages: Customer agrees that, in any event, the amount of damages or liability that Customer may recover from Company or its employees, whether arising from breach of contract, negligence, or otherwise, alleging injuries or damages of any kind, including but not limited to personal injury, pet injury, bodily injury, property damage, or property loss, is limited to actual loss or $1,000, whichever is less.

Acceptance: Check () the “ACCEPT” box below if you agree to be bound by the terms of this Agreement. Check the “DECLINE” box if you do not agree to the terms of this Agreement. If you check the “ACCEPT” box, the Agreement will be effective as of the date of acceptance.

 

___________________________    ___________________________ Print Name                                          Signature

Date:  ___________________________________


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