ENROLLMENT FORM

Please complete the form below and a member of our team will follow up with any questions or concerns.

Owner's First Name *

Last Name

Owner Email Address *

Preferred Method of Contact

Phone Number *

Dog(s) Name(s) *

Dog Details

Dog's Name *

Sex *

Male

Female

Date Of Birth *

Breed *

Color / Markings *

Spayed/Neutered *

Yes

Weight (lbs) *

Veterinarian Office: *

What name is your dog listed under at the vet? *

Veterinarian's Name

Does your dog ever show protective or possessive behavior (food / toys / treats)? If so, please explain: *

Does your dog have any touch sensitivities (head, paws, collar area)? If yes, please explain: *

Has your dog ever bitten another dog or person? If yes, please explain: *

Is your dog afraid of thunder / fireworks / loud noises? If yes, please explain: *

Has your dog ever jumped or climbed a fence / barrier? *

Yes

Feeding & Medications

Feeding Instructions: *

Breakfast

Lunch

Dinner

Amount per feeding

Eating Habits: *

Fast eater

Grazes throughout day

Possessive during meals

Food Brand *

Any special feeding instructions?

Medications

Medication Name

Dosage / Amount

Time(s) to Administer

Given with food?

Yes

Is this medication only administered on an as needed basis? If so, please share details:

Medications 2

2: Medication Name

2: Dosage / Amount

2: Time(s) to Administer

2: Given with food?

Yes

2: Is this medication only administered on an as needed basis? If so, please share details:

Medications 3

3: Medication Name

3: Dosage / Amount

3: Time(s) to Administer

3: Given with food?

Yes

3: Is this medication only administered on an as needed basis? If so, please share details:

Health & Conditions

Allergies (food / environment)? If so, please explain: *

Any major surgeries or illnesses in history? *

Has dog been sick in last 14 days? *

Yes

Does your dog have open wounds or stitches? *

Yes

Additional Health Information

Vaccinations & Records

Vaccinations On File (required): *

Rabies

Distemper

Bordetella

Upload Vaccination Records (File upload)

Agreement & Consent

I agree my dog will be on a secure leash when arriving and departing BARK BLVD. *

Yes

I agree to schedule a specific time for drop off and pick up of my dog. If I do not pick up my dog as scheduled, additional charges may be billed for the additional time my dog remains at BARK BLVD. *

Yes

If my dog is not picked up within five days of their scheduled pick up, I agree the dog will become the absolute property of BARK BLVD. All reasonble measures to reach owner and their emergency contacts will be made by BARK BLVD *

Yes

My dog has current Bordetella, Rabies, and Distemper vaccinations. These vaccinations were administered by a licensed veterinarian or within the parameters of the BARK BLVD vaccination policy. I will provide BARK BLVD a copy of my dog’s current vaccination records. I understand a waiver can be secured for the distemper vaccination requirement provided my veterinarian provides written communication stating my dog should not receive the vaccine. Waivers cannot be secured for bordetella and rabies vaccines. I understand vaccinations must be updated prior to their date of expiration to avoid a waiting period between administration and my dog’s arrival at BARK BLVD. *

Yes

I agree if fleas or ticks are found on my dog while at BARK BLVD, I will pay the cost of bathing my dog and additional facility cleaning if needed to ensure others are not exposed to the pests. BARK BLVD will contact me in the event fleas or ticks are found. *

Yes

I will not hold BARK BLVD responsible for illness or the expense related to illness. I have read the information provided to me on the BARK BLVD website and available in paper form in regard to canine illnesses (including CIRDC). I understand some canine diseases are contagious and I assume the risk associated with my dog coming into close contact with other dogs while at BARK BLVD. *

Yes

As a dog owner, I understand I am responsible for any actions, claims, losses, damages, liabilities, and added expenses arising from my dog’s stay at BARK BLVD. This includes, but is not limited to, damage or injury to person, property, or animals. This release applies to and is binding upon my heirs, family members, and anyone else asserting such a claim. *

Yes

I agree to indemnify and hold harmless BARK BLVD, its directors, officers, agents, employees and affiliates from any and all actions, claims, losses, damages, liabilities, and added expenses, including legal fees arising from my dog’s stay at BARK BLVD, or my violations of this agreement. *

Yes

If my dog becomes ill or injured, BARK BLVD has my permission to consult my regular veterinarian or an emergency veterinarian and provide such care or treatment as may be recommended. I agree the expense for such consultation or necessary treatment will be paid by me (dog owner). In the event of this type of emergency, I will be notified by BARK BLVD as soon as possible. *

Yes

I understand, while highly unlikely, it is possible for elderly dogs to pass away while at BARK BLVD. If this should happen, I will be contacted immediately. If I cannot be reached BARK BLVD will call the emergency contact listed on my account. If neither party can be reached BARK BLVD will contact my dog’s veterinarian. Immediate transport of my dog is required. BARK BLVD will transport my dog to my veterinarian or a specialty veterinary center. A trip charge will apply. *

Yes

My dog has not been sick within the last 14 days. *

Yes — has not been sick

No — has shown signs of illness

My dog does not have open wounds or stitches. *

Yes — my dog is free of wounds/stitches

No — has wounds/stitches

Medications / Ointments / Supplements

I agree to provide all required medications/ointments/supplements my dog may need while at BARK BLVD. Each time my dog arrives at BARK BLVD, I will provide clear concise instructions for administering said products and confirm with a signature the information BARK BLVD has on file is correct. I will bring prescription medication and supplements in its original container. I will provide a syringe for each administration of insulin to be injected, if my dog is diabetic. *

Yes

I agree my dog will not be allowed to leave BARK BLVD until all charges due are paid in full or both parties agree upon payment arrangements. If collection proceedings are necessary, I will be responsible for any and all attorney fees, regardless of whether an action is filed. *

Yes

I understand prepaid daycare packages are nonrefundable and expire 12 months from purchase date. Discounted packages are provided only if they are paid for in advance. *

Yes

Photo / Video Rights

BARK BLVD has the right to take photographs and/or videos of Owner’s dog(s) while in the facility’s care. BARK BLVD may post or reproduce any and all photographs/videos taken (as well as dog(s) name) on or in, without limitation, website, social media sites or promotional materials without becoming liable to the Owner (or the Owner’s dog(s)) for any royalty payment. Owner hereby releases, covenants not to sue, and forever discharges the facility of and from any and all claims, demands, rights, and causes of action of whatever kind or nature. *

Yes

Daycare Play Consent *

I agree my dog may play with other dogs.

I agree my dog may play with sibling dogs from the same household.

I agree my dog may play only with a staff person.

Signature

Owner Signature *

Form Submission Date *