Name:

Address:

Phone:                                            Work Phone:
              
E-mail address:

Name of your Dog(s):

Breed(s) and Age(s):

Veterinarian:

Veterinarian Address / Phone:

Emergency Contact:


Services Requested:
Feeding
Grooming
Exercise
Transportation
Agility/Fly Ball Practice

Feeding Instructions:

Additional Information or Services needed:

Please check any FALSE statement below:
My dog does not have fleas, ticks, or ear mites
My dog is allowed to practice on agility equipment
My dog is allowed to play with other dogs
My dog does not have any known illness or food allergies
My dog is current on all vaccinations
My dog does not have history of aggressive behavior toward animals or children
My dog is allowed to swim
My dog is allowed to be transported by GDP employees, agents, heirs.
My dog is allowed treats provided by GDP
My dog does not require medication to be administered
My dog may be bathed without concern of skin reactions or allergies
My dog can be crated if necessary
My dog does not require a muzzle

Please explain any checked items above:

Terms Of Agreement:
I understand that GenevaDogandPony.org is bonded and insured. I waive the aforementioned employees, agents, heirs of any and all liability THAT IS NOT the result of gross negligence or malice. I understand that the care of my pet will be administered according to the information I have provided above and that any omissions on my part could result in damages to my pet or to the caregivers; I will be responsible for indemnifying the damaged party should such damages occur.

GenevaDogandPony.org employees, agents, and heirs have my expressed consent to seek veterinary care for my pet in the event of an emergency. When possible the vet listed above will be contacted and enlisted to treat my pet, however in the event that vet listed above is unavailable or for any other reason cannot perform services required (i.e., geographically prohibitive or specialized services required, etc.) GenevaDogandPony.org employees, agents, or heirs have full discretion to seek required services and use their best judgment. I understand that I will compensate and/or reimburse them for services and aid rendered.
I have read and understand the above Terms Of Agreement, and AGREE to the terms.
I DO NOT agree to the above Terms Of Agreement, please call me to discuss.
(authorized signature will be required for Pet Services Agreement)