Dog's Name
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Breed & Description
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Birthday/Adoption Date
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MM
DD
YYYY
Weight
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Sex
Female
Male
Spayed/Neutered
*
Yes
No
Owner's Name
*
First Name
Last Name
Owner's Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Owner's Email
*
Phone
*
(###)
###
####
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
(###)
###
####
Emergency Contact Email
*
Vaccinations
Vet Name
First Name
Last Name
Vet Clinic & Location
*
How did you hear about us?
Google
Facebook
Nextdoor
Drive-By
Flyer
Event
Referral
Other
Referral Name/Describe Other
Have you ever used another daycare/boarding facility?
No
Yes
What are the primary reason(s) for bringing your dog to UniFURsity?
Which services are you looking for?
Are there any other services you wish we offered?
Is there any person, dog, or situation your dog seems to be uncomfortable with?
How long have you had your dog?
Has your dog ever growled at or bit another person or dog?
Can you take a food item away from your dog without him/her growling?
Will your dog readily share toys with others?
May we take your dog for a walk?
May we give your dog a bath?
Are there any areas on your dog's body where he/she does not like to be touched?
Has your dog ever socialized with a large group of dogs?
Does your dog play well with dogs of all sizes?
Is your dog afraid of thunderstorms?
Are there any restrictions that should be placed on your dog's activities?
Is it ok if your dog has a bedtime snack if boarding?
If your dog is not eating their food, do you have a preference on what we can offer to entice eating?
Does your dog have any allergies or any other conditions?
Medications: Please list all medication, dosage and frequency information for any medications your dog requires.
Feedings: Please list food brand, quantity and any special instructions. We feed in the morning and evening. (Boarding Only)
Persons authorized to pick up/drop off, please list.
Is there anything else we should know?
Application Signature
*
I, the undersigned, hereby acknowledge and agree that all the information provided in this application is complete and accurate to the best of my knowledge. I consent to UniFURsity Club’s
use of such information for all lawful business purposes which may include, but is not limited to, for example, providing services to you, operating the business, and using data that includes
information about you and your dog for marketing or other purposes. I further acknowledge and agree that I have read, understand, and agree to all the terms and conditions contained in the Release, Waiver of Liability, Assumption of Risk and Indemnification Agreement, as they may be amended from time to time, which are attached and fully incorporated into this application. I
hereby execute this Application and the Agreement for my dog, myself and my heirs, successors, representatives and assigns. I further attest that if I am not the owner or sole owner of the dog(s) for whom this application has been completed, my signature is sufficient to enter into this agreement for and on behalf of any other owner or representative. If signing electronically, I
hereby agree that my signature will be deemed an original and take the place of my wet-ink signature. If signing in ink, I hereby agree that a true and correct copy of this document may be produced in lieu of the original application. Should a copy be produced, I understand that it is legally enforceable and does not affect the terms of the application in any way.
Date
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MM
DD
YYYY
RELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT (THE "AGREEMENT")
THIS AGREEMENT INCLUDES A RELEASE OF LIABILITY AND WAIVER OF LEGAL RIGHTS AND DEPRIVES YOU OF THE RIGHT TO SUE THE OWNER(S) OF ANY UNIFURSITY CLUB LLC OR
RELATED PARTIES. DO NOT SIGN THIS AGREEMENT UNLESS YOU HAVE READ AND UNDERSTAND IT IN ITS ENTIRETY. SEEK THE ADVICE OF LEGAL COUNSEL IF YOU ARE
UNSURE OF ITS EFFECT.
In consideration for your dog(s) being permitted to come to UniFURsity, you agree to all of the policies, procedures, release, terms and conditions set forth below.
1. All dogs must:
• be current on Rabies, Distemper, and Bordetella vaccinations;
• be at least 4 months of age;
• be spayed or neutered if 6 months of age or older;
• be in general good health and free of ticks and fleas;
• be non-aggressive towards other dogs and people;
• not be protective of toys;
• complete the interview process to UniFURsity Club's satisfaction in its sole discretion;
• meet all municipal and state licensure and other requirements;
• have a quick release collar; and,
• be leashed when entering and exiting the facility.
2. Food. Dogs will be fed in accordance with the instructions provided in the application or instructions you later provide.While at UniFURsity, dogs do not eat lunch. If you want your dog
to eat lunch, you must provide a container marked with your dog's name and feeding instructions.
3. Photography and video Release. By using the services offered by UniFURsity, you agree to allow UniFURsity to use your dog's name and any image or likeness of your dog taken while
at our facility, in any form or format, for use, at any time, in any media, marketing, advertising, illustration, trade or promotional material. This provision is binding on you, and all of your
successors, heirs, legal representatives and assigns.
4. Personal Property. UniFURsity will not be liable for any lost, stolen or damaged personal property belonging either to you or your dog. If your dog causes any personal property damage
to the facility, the site where you will be liable for the full cost of all treatment, repairs, and replacements.
5. Fees. You must pay for all services by credit card or debit card. All payment is due at the time you pick up your dog. You give your express permission for UniFURsity to charge any
credit card you provided for unpaid services or products upon the date services were supposed to have been completed. You further agree to pay any collections costs and the cost of
any returned or challenged check or debit charges.
6. Aggressive Dogs. Although we love all dogs, your dog may not be aggressive and must pass UniFURsity’s interview process in UniFURsity’s sole discretion. Your dog may be separated
from other dogs or asked not to return to the facility if he/she exhibits aggressive or other unacceptable behavior. Such determinations will be made at the sole discretion of UniFURsity Club.
7. Abandoned dogs. No dog may be left at UniFURsity after the scheduled pick up time without communication from you. If your dog is left at UniFURsity without any contact, instruction or
notification regarding its pick up from your or your authorized representative, your dog will be deemed “abandoned” at 7 PM on the seventh day after the scheduled pick up date. If
abandoned, UniFURsity will become its legal owner and guardian. UniFURsity will, in its sole discretion, determine whether to rehome the dog or relinquish it to a shelter or rescue of
UniFURsity's choice. YOU FULLY UNDERSTAND AND AGREE THAT IF YOU ABANDON YOUR DOG AT UNIFURSITY, YOU MAY BE UNABLE TO RETRIEVE POSSESSION OF YOUR DOG
AND WILL HAVE NO RECOURSE AGAINST UNIFURSITY CLUB.
8. Duty to Disclose. You must disclose on a continuing basis, any and all medical or other conditions, including but not limited to personality concerns or behavioral incidents that in
UniFURsity’s sole discretion, may affect, limit or prevent your dog's ability to participate in any UniFURsity activity or service.
9. ACCEPTANCE AND ACKNOWLEDGMENT OF RISK. YOU FULLY UNDERSTAND THAT: (a) THERE ARE INHERENT AND POTENTIAL RISKS INVOLVED WITH INTERACTIONS
BETWEEN HUMANS AND DOGS, AS WELL AS BETWEEN DOGS AND OTHER DOGS,WHICH MAY RESULT IN PROPERTY DAMAGE OR BODILY INJURY, INCLUDING BUT NOT LIMITED TO, PERMANENT DISABILITY, SICKNESS OR DEATH TO HUMAN OR DOG; AND (b) THERE MAY BE OTHER RISKS NOT KNOWN TO YOU OR UNIFURSITY, NOR READILY
FORESEEABLE AT THIS TIME (COLLECTIVELY, "RISKS"). YOU FULLY ACCEPT AND ASSUME ALL RISKS AND RESPONSIBILITY FOR ALL RISKS, INCLUDING, WITHOUT LIMITATION, ALL LOSSES, COSTS AND DAMAGES INCURRED AS A RESULT OF YOUR DOG'S PARTICIPATION AT UNIFURSITY, INCLUDING ANY VETERINARIAN EXPENSES
INCURRED ON BEHALF OF OR CAUSED BY YOUR DOG. "SICKNESS" INCLUDES ANY ILLNESS NOT LIMITED TO BORDETELLA (KENNEL COUGH), BLOAT, OR ANY OTHER FORM OF CONTAGIOUS DISEASE.
10. Veterinarian Liability and Care. UniFURsity will have the right to obtain medical treatment for your dog, if, in UniFURsity's sole discretion, it appears that your dog may be ill, injured or exhibits any other behavior that would reasonably suggest that your dog may need medical treatment. UniFURsity will first attempt to seek treatment from the veterinarian provided in the application, but will have the right to seek veterinary treatment from an alternative veterinarian if it is unable to reach or transport the dog to such veterinarian. If a dog passes
away at UniFURsity, it will be brought to its or the nearest veterinarian. YOU WILL BE FULLY RESPONSIBLE FOR ALL COSTS RELATED TO ANY MEDICAL TREATMENT, INCLUDING WITHOUT LIMITATION, THE COST OF ANY TRANSPORTATION FOR THE PURPOSE OF SUCH TREATMENT. You must also provide veterinary records to UniFURsity upon request.
11. WAIVER, RELEASE AND INDEMNIFICATION. YOU HEREBY AGREE TO EXPRESSLY AND FOREVER GENERALLY WAIVE, DISCHARGE CLAIMS, INDEMNIFY, RELEASE FROM
LIABILITY, SAVE, HOLD HARMLESS AND DEFEND UniFURsity, their invitees, owners, officers, directors, employees, contractors, volunteers, agents, representatives, and all others having
an interest in any UniFURsity party (collectively, the "Releasees") from and against ANY AND ALL INJURY, LIABILITY, CLAIMS, LITIGATION, ACTIONS, SUITS, COSTS, LOSSES, DAMAGES, ATTORNEY'S FEES, EXPENSES OR DEMANDS OF EVERY CHARACTER WHATSOEVER on account of, arising out of, resulting from or relating in any way to (i) any act or omission of the Releases, (ii) your dog's participation at UniFURsity. YOU AGREE THAT THIS RELEASE IS BINDING ON YOU AND YOUR SUCCESSORS, HEIRS, LEGAL
REPRESENTATIVES AND ASSIGNS. YOU ALSO EXPRESSLY AND FOREVER RELEASE UNIFURSITY FROM ANY DUTY TO PROTECT YOU OR YOUR DOG FROM INJURY OF ANY KIND, AND AGREE THAT ANY IMPLEMENTATION OF SAFETY PRECAUTIONS BY UNIFURSITY WILL NOT WAIVE UNIFURSITY'S RIGHT TO BE INDEMNIFIED AS PROVIDED HEREUNDER,
AND SUCH PRECAUTIONS WILL NOT ALTER THIS RELEASE.
Check the following to acknowledge.
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AGREEMENT SIGNATURE
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