Critter Care Camp, LLC 
Canine Camper Information 

Welcome to Critter Care Camp. We are excited that you are considering Critter Care Camp for day care and/or 
boarding for your pet, your "Camper". 
	Camper Name ____________________________________
		Breed ______________________________________
Birth Date ____/____/____ Color ___________________
Sex:   ____________             Is Camper is Spayed/Neutered ____________
Owner's Name, _____________________________________________________________________ 
Address ____________________________________________________________________________
City __________________________________________State _______________Zip _______________
Home Phone #  (_____) ___________________Work Phone # (_____) __________________________
Cell # (_____) _______________________________
E-Mail Address _______________________________________________________________________
Veterinarian Hospital ___________________________________________________________________
	Address _______________________________________________________________________
	City ____________________________________State __________Zip _____________________
	Contact Name__________________________ Phone (__) ____________

Vaccinations: Owner is required to provide veterinary proof of current Rabies, Distemper and 
                       Bordetella.  
If we think that something is out of the ordinary with your pet, we will call you and describe the situation. It then becomes your responsibility to make a decision as to veterinary intervention. If we are unable to contact you and  we feel that immediate medical attention is necessary, we will transport your pet to your designated veterinarian's office for examination and/or treatment. The cost of this medical treatment will be your responsibility. 

Emergency Contact 
	Name: ________________________________________________(someone not traveling with you) 
	Relationship ________________________________	Home Phone # ( ____) _________________ 
		Work Phone # ( ____) ________________ 
		Cell Phone #" ( ______) _________________ 

Diet:
How often and how much do you feed your Camper?  __________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

•	Is it OK if your Camper has a Campfire treat (Animal Crackers) at bedtime if boarding?
•	If your Camper is not eating his/her food, do you have a preference on what we can offer to entice 
eating? _________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________
Does your camper have any allergies or any other conditions?  O Yes    O No
If yes, please explain_________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________
Medications: O Yes   O No  (Please list all medications)
	Medication _______________________________________Quantity ________________________ 
O  Morning                                      O Afternoon                                               O Evening 
	Medication _______________________________________Quantity ________________________ 
O  Morning                                      O Afternoon                                               O Evening 
	Medication _______________________________________Quantity ________________________ 
O  Morning                                      O Afternoon                                               O Evening 

COMPLETE THIS SECTION ONLY IF YOU WISH YOUR CAMPER TO HAVE GROUP PLAYTIME
•	Has your Camper ever socialized with a large group of dogs (8 or more)?  O Yes    O  N o 
•	How long have you had your camper _______________________________________________
•	Is there any PERSON, type of DOG, or SITUATION your Camper seems to be uncomfortable with? O Yes O No 
If yes, please describe ______________________________________________________________
________________________________________________________________________________________________________________________________________________________________
•	Has your Camper ever growled at or bit another PERSON or DOG? Q Yes Q No 
If yes, what were the circumstances?__________________________________________________
_______________________________________________________________________________________________________________________________________________________________
•	Are there any areas your Camper's body where he/she DOES NOT like to be touched by humans?
                 O Yes      O No 
If yes, which areas?_____________________________________________________________
__________________________________________________________________________________________________________________________________________________________
•	Can you take food away from your Camper without him/her growling? oYes Q No 
•	Will your Camper readily share toys with other dogs? Q Yes Q No 
If No, Please describe _____________________________________________________________
______________________________________________________________________________________________________________________________________________________________
•	Has your Camper ever jumped a fence or barrier? Q Yes Q No 
•	Does your Camper to dig out of enclosures? Q Yes Q No 

•	Does your Camper play well with dogs of all sizes? 0 Yes 0 No 
	If No, Please describe _____________________________________________________________________
________________________________________________________________________________________
•	Is your Camper afraid of thunderstorms? O Yes O no 
If yes, how do we make him/her feel comfortable: _______________________________________
______________________________________________________________________________________________________________________________________________________________
•	Are there any restrictions that should be placed on your Camper's activities? o Yes 0 No 
If yes, please describe_______________________________________________________________________

Camper Release, Waiver of Camper Release, Waiver of Liability, Assumption of Risk and Indemnification Agreement

I, the undersigned, hereby acknowledge and agree that all the information provided in this Camper Application is complete and accurate to the best of my knowledge. This information will not be shared with outside sources. 
 
Hours of operation are:
7:30 AM to 6:00 PM Monday through Friday; 
9:00 AM - 12:00 Noon on Saturday and 
5:00 PM to 6:00 PM on Sunday. 
I understand that I am expected to pick my pet up before 6:00 PM on the day scheduled. Should it be necessary to leave my pet beyond that time, I must notify Critter Care Camp as soon as possible.  The cost to board another day will be added for pick-up two hours beyond that time. A grace period of one week will be allowed, but any pet that is not picked up after that time will be turned over to rescue. 
A copy of the certificate of current Rabies, Parvo, Distemper and Bordetella vaccinations must be on file 
Owners provide food and any medication necessary. 
I further acknowledge and agree that I have read, understand and agree to all the terms and conditions 
contained in the Camper Release, Waiver of Liability, Assumption of Risk and Indemnification 
Agreement,. 
	Owner's Signature _______________________________________________________________
	Printed Name ________________________________________Date ______________________

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 CRITTER CARE CAMP.  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.

RELEASE OF LIABILITY AND WAIVER OF LEGAL RIGHTS

In consideration for your pet(s) being permitted to come to Critter Care Camp, you agree to all of the policies, procedures, release, terms and conditions set forth below. 
VACCINATIONS:  Dogs must be current on Rabies, Distemper, Parvo and Bordetella vaccinations; Cats must be current on Rabies and FRVCP.
CONDITION:  Pets must be in general good health and free of ticks, fleas and lice.  
FOOD:  Pets will be fed in accordance with the instructions provided in the Pet Application or instructions you later provide. Day Care pets do not get fed lunch. If you want your Pet to eat lunch, you must provide the Camp a container marked with your Pet’s name and feeding instructions.
PERSONAL PROPERTY: Critter Care Camp will not be liable for any lost, stolen or damaged personal property belonging either to you or your Pet. If your Pet causes any personal property damage to the facility or another Pet or otherwise, you will be liable for the full cost of all treatment, repairs and replacements.
FEES: You must pay for all services and products by cash or check. All payment is due at the time you pick up your Pet from Camp. You further agree to pay any collections costs and the cost of any returned or challenged check or debit charges.
AGGRESSIVE DOGS: Although CBW loves all dogs, to come to Camp, your Pet may not be aggressive.  Your dog will be separated from other dogs or asked not to return to Camp if he/she exhibits aggressive or other unacceptable behavior. Such determinations will be made at the sole discretion of Critter Care Camp.
ABANDONED PETS: No pet may be left at Camp after the scheduled pick up time without communication from you. If your pet is left at Camp without any contact, instruction or notification regarding its pick up from you or your authorized representative, your pet will be deemed “Abandoned” at 7 P.M. on the seventh (7th) day after the scheduled pick up date. If your pet is abandoned at Camp, Critter Care Camp will, in its sole discretion, determine whether to rehome the pet or relinquish it to a shelter. YOU FULLY UNDERSTAND AND AGREE THAT IF YOU ABANDON YOUR PET AT CAMP, YOU MAY BE UNABLE TO RETRIEVE POSSESSION OF YOUR DOG AND WILL HAVE NO RECOURSE AGAINST CRITTER CARE CAMP .
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 may affect, limit or prevent your Pet’s ability to participate in any Camp activity.
ACCEPTANCE AND ACKNOWLEDGMENT OF RISK:   YOU FULLY UNDERSTAND THAT: (a) THERE ARE INHERENT AND POTENTIAL RISKS INVOLVED WITH INTERACTIONS BETWEEN HUMANS AND DOGS AND CATS, AS WELL AS BETWEEN DOGS AND OTHER DOGS AND CATS, WHICH MAY RESULT IN PROPERTY DAMAGE OR BODILY INJURY, INCLUDING BUT NOT LIMITED TO, PERMANENT DISABILITY, SICKNESS OR DEATH TO HUMAN OR DOG OR CAT; AND (b) THERE MAY BE OTHER RISKS NOT KNOWN TO YOU OR CRITTER CARE CAMP, 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 PET’S PARTICIPATION AT CAMP, INCLUDING ANY VETERINARIAN EXPENSES INCURRED ON BEHALF OF OR CAUSED BY YOUR PET. “SICKNESS” INCLUDES ANY ILLNESS NOT LIMITED TO BORDETELLA (KENNEL COUGH), BLOAT, OR ANY OTHER FORM OF CONTAGIOUS DISEASE.
VETERINARIAN LIABILITY AND CARE. Critter Care Camp will have the right to obtain medical treatment for your pet, if, in Critter Care Camp’s sole discretion, it appears that your pet may be ill, injured or exhibits any other behavior that would reasonably suggest that your pet may need immediate medical treatment. In the event that Critter Care Camp cannot get in touch with you to take care of the issue, Critter Care Camp will first attempt to seek treatment from the veterinarian provided in the Pet Application, but will have the right to seek veterinary treatment from an alternative veterinarian if it is unable to reach or transport the pet to such veterinarian. If a pet passes away at Camp, 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 Critter Care Camp upon request.
WAIVER, RELEASE AND INDEMNIFICATION. YOU HEREBY AGREE TO EXPRESSLY AND FOREVER GENERALLY WAIVE, DISCHARGE CLAIMS, INDEMNIFY, RELEASE FROM LIABILITY, SAVE, HOLD HARMLESS AND DEFEND Critter Care Camp, their invitees, owners, officers, directors, employees, contractors, volunteers, agents, representatives, lessors, and all others having an interest in any Critter Care Camp 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 Releasees, (ii) your Pet’s participation at Camp, YOU AGREE THAT THIS RELEASE IS BINDING ON YOU AND YOUR SUCCESSORS, HEIRS, LEGAL REPRESENTATIVES AND ASSIGNS. YOU ALSO EXPRESSLY AND FOREVER RELEASE CRITTER CARE CAMP FROM ANY DUTY TO PROTECT YOU OR YOUR PET FROM INJURY OF ANY KIND, AND AGREE THAT ANY IMPLEMENTION OF SAFETY PRECAUTIONS BY CRITTER CARE CAMP WILL NOT WAIVE CRITTER CARE CAMP’S RIGHT TO BE INDEMNIFIED AS PROVIDED HEREUNDER, AND SUCH PRECAUTIONS WILL NOT ALTER THIS RELEASE.