New Client Form Your Name * Spouse Name Address (Address, City, State, Zip) Home Phone Cell Phone * Work Phone Email * How were you referred: Please provide name(s) of anyone else authorized to pick up my pet, other than your Spouse (Please note, PPH will not release your pet to anyone without specific permission to do so): Additional Authorized Person(s) EMERGENCY CONTACT INFORMATION Emergency Contact Person Relationship Emergency Phone # REGULAR VETERINARIAN INFORMATION Clinic/Vet Name Vet Phone Acknowledgement My signature below is in acknowledgement of the following (please read carefully): I accept full financial responsibility for any charges incurred by my Pet while participating in Boarding, Daycare, Grooming or any other services at Pet Palace Hotels. I also understand that payment is due at time of services. I further acknowledge that payment is due at time of services, that payment can be made by credit card, check, or by exact cash and that there is a $35.00 Returned Check fee. I understand that all boarding pets participate in Doggie Daycare, unless otherwise indicated, and that attendance is not without risk to my dog. I hereby waive and release Pet Palace Hotels and its employees from any and all liability of any nature for any injury or damage which my dog may suffer, including but not limited to injury or damage resulting from the action of any dog or from use of or presence upon premises’ equipment, and I expressly assume the financial responsibility should my pet require veterinary care to address any medical issues related to participation in Doggie Daycare. I hereby agree to indemnify and hold harmless Pet Palace Hotels and its employees from any and all claims. EMERGENCY CONSENT TO TREAT Pet Palace Hotels will make every effort to contact you or your Responsible Party in the event of an emergency. Our primary concern is ensuring your pet’s comfort and his/her ability to receive rapid medical treatment should problems occur. _(SIGN INITIALS BELOW)_ I give my permission to have Pet Palace Hotels take initial measures to treat my pet for any medical issue(s) that should occur. If standard protocols do not correct the problem and an exam with the veterinarian is indicated, I authorize the on-call veterinarian to treat my pet based on their professional recommendations and I accept full financial responsibility. The above conditions have been explained to me and I understand that I am responsible for all costs incurred for any exams, diagnostics and treatments provided. Furthermore, I authorize Pet Palace Hotels (and/or authorized agents) to transport my pet to a veterinarian Pet Palace Hotels chooses for treatment including, but not limited to, emergency services or routine care, such as vaccinations, if necessary. I understand unforeseen circumstances can and do arise and do hereby release Pet Palace Hotels, the veterinarian and staff from being held liable for any injury or death to my pet during transportation and/or treatments. Initials Clear YOUR PET INFORMATION Pet's Name Breed Color Your Pet's Birthday Gender Has Your Pet Been Spayed/Neutered? Please list any medical conditions your pet has (i.e. arthritis, diabetes, seizures, etc): Please List Any Medication Your Pet Takes Regularly Medication / Dosage / Frequency Please Check All That Apply Cage Aggression Thunder Phobia Food Aggression Chews/Destroys Toys or Bedding Coprophagia (Poop Eater) Dog Aggression Pet Name(s) Signature Clear Today's Date If you are human, leave this field blank. Submit
