Page 1 of 4
Boarding Application
Emergency Contact Information
Guardian’s/Owner’s Name__________________________________________________________________
Address ___________________________________________ City _________________State ___ Zip _______
Home Phone # (___) _______________ Work# (___) _________________ Cell # (___) __________________
E-Mail Address ________________________________ Web Address ________________________________
Dog’s Name________________________________ Birth Date___/____/___ Color ______________________
Breed ___________________ Male Female Neutered/Spayed Functional Weight: _____________lbs.
Have you ever used Doggy Day/Overnight Boarding services?
Yes
No
Please list _________________________________________________________________________________
EMERGENCY CONTACT NAME (someone not traveling with you)
Name: _______________________________________________________Relationship __________________________
Home Phone # (____) __________________ Work # (____) _________________Cell # (____) ____________________
This Person is authorized to Drop Off and/or Pick-Up My Dog(s) _____________________________________________
CANINE BEHAVIOR QUESTIONS: (Please answer the following questions as accurately as possible.)
Is there any PERSON, type of DOG, or SITUATION your dog seems uncomfortable with?
Yes
No
Please describe _____________________________________________________________________________
How long have you had your Dog? _____________________________________________________________
Where did you get your Dog? _________________________________________________________________
Has your Dog ever growled at or bit another PERSON or DOG?
If yes, what were the circumstances? ____________________________________________________________
Can you take a food item away from your dog without him growling?
Yes
No
Does your dog have any allergies or any other conditions?
Yes
No
Is your dog leash trained?
Yes
No
Are there any areas on your dog’s body where he/she DOES NOT like to be touched by humans? Yes No
If yes, please describe? ______________________________________________________________________
Is there anything that we should know about your dog that has not been covered?
Yes
No
Does your dog demonstrate symptoms of stress when separated from owner (i.e. chewing, barking, and
scratching?) Yes
No Please Describe: _____________________________________________________
If YOUR DOG WILL BE USING THE DAYCARE FACILITY DURING THIS VISIT: (Please answer the
following questions as accurately as possible.)
Has your dog ever socialized with a large group of dogs? (8 or more)
Yes
No
Has your dog ever played with dogs less than 15 pounds?
Yes
No
Are there any restrictions that should be placed on your dog’s activities?
Yes
No
If yes, what activities? _______________________________________________________________________
Will your dog readily share toys with other dogs?
Yes
No
Has your dog ever jumped a fence or barrier?
Yes
No
Page 2 of 4
Medications/Vaccinations
Feedings
Payment Information
Signature
VETERINARIAN:
Veterinarian Hospital ______________________Contact Name ________________ Phone# (____) _________
Address __________________________ City ____________________ State _______Zip __________
VACCINATIONS: Guardian/Owner is required to provide veterinary proof of current and updated vaccinations: Dates
must be verified and initialed by Pearland Barkway Staff.
Rabies ______________
Distemper ______________
Bordetella ____________
MEDICATIONS: No Yes (Please list all medications.)
Medication _________________________________
Morning
Afternoon
Evening
Quantity ____________
Medication _________________________________
Morning
Afternoon
Evening
Quantity ____________
Medication _________________________________
Morning
Afternoon
Evening
Quantity ____________
FEEDINGS: Client Provided – Brand Name ______________________________ House Food - $3.00 per day extra
Morning Quantity _____________
Afternoon Quantity _____________
Evening Quantity _______________
Special Instructions _______________________________________________________________________________
Please Describe Special Diets and Allergies____________________________________________________________
METHOD OF PAYMENT: Payment in full will be provided at time of pick-up and includes all fees incurred
during your pet’s stay (i.e. grooming, house food, damages, etc.). Personal checks may not be accepted for
boarding payments.
READ CAREFULLY. THIS AGREEMENT INCLUDES A RELEASE OF LIABILITY AND WAIVER OF
LEGAL RIGHTS AND DEPRIVES YOU OF THE RIGHT TO SUE PEARLAND BARKWAY AND RELATED
PARTIES. DO NOT SIGN THIS AGREEMENT UNLESS YOU HAVE READ IT IN ITS ENTIRETY. SEEK
THE ADVICE OF LEGAL COUNSEL IF YOU ARE UNSURE OF ITS EFFECT.
I, the undersigned, hereby acknowledge and agree that all the information provided in this Boarding Application is
complete and accurate to the best of my knowledge. I further acknowledge and agree that I have read, understand and
agree to all terms and conditions contained in the Pearland Barkway Policies, Procedures and Boarding Release, Waiver
of Liability, Assumption of Risk, and Indemnification Agreement (the “Agreement”), as they may be amended from time
to time, which are attached and fully incorporated into this application for reference. I hereby execute the Agreement for
my dog, myself and my heirs, successors, representatives and assigns. I further attest that if I am not the sole owner or
representative of the dog subject to this application that my signature is sufficient to enter into this Agreement for and on
behalf of any other owner or representative.
______________________________
Guardian's/Owner's Signature
______________________________________ ____________
Guardian's/Owner's Printed Name
Date
Page 3 of 4
RELEASE OF LIABILITY
WAIVER OF LEGAL RIGHTS
Please read and initial each of the following statements. In consideration for my dog being permitted to be
boarded at PEARLAND BARKWAY (herein after “PB”) for daycare or boarding, I make the following
representations and agree to all of the following policies, procedures, terms and conditions:
1. _____ FOOD. I understand that my Dog’s current diet is best, but if I fail to provide Pearland Barkway with this
food, the house food will be provided at additional cost of $3 per day. The house food will be Blue Buffalo according
to my feeding instructions. In the event the I choose alternate foods, the full purchased price will be added to fees.
2. _____ PERSONAL PROPERTY. I may bring clothing, blankets or my dog’s favorite toys for their stay. I agree that
Pearland Barkway shall not be responsible or liable for any lost, stolen or damaged personal property belonging either
to me or my Dog.
3. _____ COLLARS AND LEASHES. My dog will be leashed when they enter Pearland Barkway. I also understand
and agree that my Dog's collar may be removed in the play/boarding area to prevent injury to self or other Dogs.
4. _____ AGGRESSIVE DOGS. My dog is not aggressive. Pearland Barkway loves dogs, but cannot accept aggressive
dogs. If my dog behaves aggressively or demonstrates unacceptable behavior he/she will be separated from the other
dogs. We will use reasonable efforts to consult Guardians/Parents about aggression and ways to address it, however
aggressive dogs may be asked not to return to PEARLAND BARKWAY. This policy is the sole discretion of
Pearland Barkway management.
Sign Here ____________________________________________________________________________________
5. _____ PHOTO RELEASE. I agree to allow PEARLAND BARKWAY employees to use my Dog’s name and any
photographs taken while at Pearland Barkway Boarding or Daycare facility, for marketing or advertisement purposes.
I agree that this provision shall be binding on me and all of my successors, heirs, legal representatives and assigns.
This will also apply to (Future Option) Pearland Barkway Daycare CAM, where I may observe my DOG playing with
other daycare Dogs by logging onto www.pearlandbardway.com and clicking on the Daycare Play Tab.
6. _____FEES. Pearland Barkway Boarding/Daycare FEES. I agree to pay for all fees, services and products with a
credit card, or by cash at the time I pick up my DOG after each visit to PEARLAND BARKWAY. I further agree to
pay the cost of any debit charges returned or challenges for to any reason.
7. _____ CANCELLATION POLICY. I understand that I will be charged for a full day of day BOARDING, if I fail to
cancel my reservation twenty four (24) hours in advance or do not pick up my dog by 6:00 PM.
8. _____ ABANDONED DOGS. Pearland Barkway will provide a safe and fun environment for your DOG. No dog
may be abandoned at PEARLAND BARKWAY. I agree that I will not neglect to pick up my DOG from boarding or
dayare by the time he/she is scheduled to leave without providing notification. Any DOG that is left at PB without any
contact, instruction or notification from me, or the ability, willingness or plans to pick him/her up by myself or my
personal representative or agent, will be considered abandoned.
I understand that if I abandon my DOG, PEARLAND BARKWAY will, by default, become the legal owner and
guardian of the DOG. PB will, in its sole discretion, determine whether to try to rehome and adopt the DOG or will
relinquish to the Pearland Animal Shelter. I FULLY UNDERSTAND AND AGREE THAT IF I ABANDON MY DOG AT
PEARLAND BARKWAY, I MAY BE UNABLE TO RETRIEVE POSSESSION OF MY DOG AND WILL HAVE NO
RECOURSE AGAINST PEARLAND BARKWAY AS PROVIDED FOR BELOW.
Page 4 of 4
9.
_____ DAMAGE. If my DOG causes any damage to the PB facilities or equipment, I agree to be fully responsible for the full
cost of any repair or replacement. This includes, cots, doors, fixtures, etc.
10. _____ DUTY TO DISCLOSE. I have disclosed and shall continue to disclose on an ongoing basis, any and all medical or other
conditions, including but not limited to personality concerns or behaviors that may affect, limit or prevent my DOG's ability to
participate in play time or otherwise attend PB boarding facility or daycare.
11. _____ DAYCARE PARTICIPATION. I understand that participation in play time is at the sole discretion of Pearland Barkway
and that my DOG may be separated from other Dogs or asked to leave for legitimate reasons.
12. _____ ACCEPTANCE AND ACKNOWLEDGEMENT OF BOARDING PARTICIPATION RISK. I 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 ME NOR
READILY FORESEEABLE AT THIS TIME (COLLECTIVELY, “RISKS”). I FULLY ACCEPT AND ASSUME ALL RISKS
AND RESPONSIBILITY FOR ALL RISKS, INCLUDING, WITHOUT LIMITATION, ALL LOSSES, COSTS AND
DAMAGES INCURRED AS A RESULT OF MY OR MY DOG'S PARTICIPATION IN BOARDING OR DAYCARE,
INCLUDING ANY VETERINARIAN EXPENSES INCURRED ON BEHALF OF MY DOG. SICKNESS SHALL BE
DEFINED TO INCLUDE ANY ILLNESS INCLUDING BUT NOT LIMITED TO BORDETELLA (KENNEL COUGH) OR
ANY OTHER FORM OF CONTAGIOUS ILLNESS.
13. _____ VETERINARIAN LIABILITY AND CARE. I agree to allow Pearland Barkway to obtain medical treatment for my
DOG, if, in its sole discretion it appears that, he/she is ill, injured or exhibits any other behavior that would reasonably suggest
that my Dog may need immediate medical treatment. If a dog passes away while boarding, it will be brought to its or the nearest
veterinarian. I AGREE THAT I AM FULLY RESPONSIBLE FOR THE COST OF ANY SUCH MEDICAL TREATMENT,
AND FOR THE COST OF ANY TRANSPORTATION FOR THE PURPOSES OF SUCH TREATMENT, PROVIDED TO MY
DOG.
14. _____ WAIVER, RELEASE AND INDEMNIFICATION. I HEREBY EXPRESSLY AND FOREVER GENERALLY
WAIVE, DISCHARGE CLAIMS, INDEMNIFY, RELEASE FROM LIABILITY, SAVE, HOLD HARMLESS AND
DEFEND AND COVENANT NOT TO USE PEARLAND BARKWAY and their invitees, sponsors, advertisers, owners,
officers, employees, volunteers, leasors, and any parties owning, controlling or having any interest in the property at which the
care is taking place, and all other representatives or agents (the “Releases'”) from and against ANY AND ALL INJURY,
LIABILITY, CLAIMS, LITIGATION, ACTIONS, SUITS, COSTS, LOSSES, DAMAGES, EXPENSES OR DEMANDS
(including reasonable attorney’s fees) OF EVERY CHARACTER WHATSOEVER on account of, arising out of, resulting from
or relating in any way to any act or omission of the Releases', including negligence, and my or my Dog’s participation in activities
at PEARLAND BARKWAY, or otherwise.
15. _____ I FURTHER AGREE TO INDEMNIFY, SAVE AND HOLD HARMLESS the Release's from any claims, litigation,
actions, suits, damages, costs, attorney’s fees, losses or injuries as the result of any such claim. I AGREE THAT THIS RELEASE
SHALL BE BINDING ON ME AND MY SUCCESSORS, HEIRS, LEGAL REPRESENTATIVES AND ASSIGNS. I ALSO
EXPRESSLY AND FOREVER RELEASE PEARLAND BARKWAY FROM ANY DUTY TO PROTECT ME OR MY DOG(S)
FROM INJURY OF ANY KIND, AND AGREE THAT EVEN IF PEARLAND BARKWAY CHOOSES TO IMPLEMENT
SAFETY PRECAUTIONS, SUCH ACTIONS SHALL NOT ALTER THE FACT THAT I HAVE RELEASED PEARLAND
BARKWAY FROM ANY DUTY TO PROTECT ME OR MY DOG(S).
I HAVE READ AND FULLY UNDERSTAND THE TERMS OF THESE BOARDING AND DAYCARE POLICIES,
PROCEDURES AND DOG’s RELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY
AGREEMENT” (THE “AGREEMENT”) AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY
SIGNING IT AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR
GUARANTEE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE
GREATEST EXTENT PERMITTED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE
INVALID OR UNENFORCEABLE, THAT THE REMAINDER OF THIS AGREEMENT SHALL REMAIN IN FULL FORCE
AND EFFECT. I AGREE THAT IT IS INTENDED THAT ALL TERMS OF THIS AGREEMENT CONTROL DESPITE ANY
PARTICULAR STATUTE OR LAW THAT WOULD OTHERWISE PROTECT ME OR MY DOG(S).
______________________________
Guardian's/Owner's Signature
______________________________________ ____________
Guardian's/Owner's Printed Name
Date