Brooklin Pet Care Waiver
CLIENTS’ASSUMPTION OF RISK: Client acknowledges that the Kennel’s Premises,
and the animals, guests, items and activities thereon, pose dangers to people and
animals. Such dangers include, by way of example and not limitation, animals that can
bite, trip, knock down, and fight, indoor and outdoor surfaces that may be slippery,
equipment that can trip, guests and clients who cannot control their dogs, and activities
involving Dog and/or other dogs that can result in injury from bites or other causes.
Accordingly, Client, on behalf of him/her, his/her spouse and minor children, and
anyone else whom Client brings onto Kennel Premises, assumes the risk of injuries,
losses, damages, costs and expenses by any means above described, and other
injuries, losses, damages, costs and expenses of every possible cause and description
unless inflicted intentionally or recklessly by the agents and employees of Kennel. If
your pet is injured in a dog fight or an accident, gets fleas, ticks or worms, contracts any
illness or diseases, is lost or stolen, or engages in any dangerous, vicious or unwanted
behavior, during the term of the Agreement, on Kennel premises. Client accepts the risk
of the same and agrees that Kennel shall not be held responsible for it or any resulting
injuries, losses damages, costs or expenses.
CLIENTS LIABILITY: If your pet causes property damage, or bites or in injures any pet,
animal or person during the term of this Agreement on the Kennel Premises, then Client
agrees to pay all resulting losses and damages suffered or incurred by Kennel and his
agents and employees and to defend and indemnify Kennel and his agents and
employees from any resulting claims, demands, lawsuits, losses, costs or expenses,
including attorney fees.
PAYMENT IS BY CASH ONLY__________ (New Clients) Cash or Cheque Regular
Clients
Signature: Date:
I WILL NOT BE PICKING UP MY PET, THE NAME OF THE PERSON PICKING MY
PET UP IS:
All CLIENTS:
Is your pet In Good Health____________________________________________
Is your pet Friendly towards other dogs and will not fight when put in a play
program______________________________________________________________
Has your pet ever bitten anyone, growled or nipped at any person_____________
Has your pet ever been declared a dangerous or potentially dangerous or vicious
dog__________________________________________________________________
Any new or existing heath conditions or injuries____________________________
Has your pet ever bit or acted aggressive towards any other dogs or cats________
Is your pet allowed to have blankets ____________________________________
Any other concerns that would be important in looking after your
pet___________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Treatment Authorization Form
If a life threatening illness/injury occurs, Brooklin Pet Care in its sole discretion may
engage the services of any veterinarian it deems appropriate for evaluation and
treatment.
Expenses thereof shall be paid by Owner. Owner authorizes Brooklin Pet Care to use
credit card on file for payment of veterinary services at the time service is provided.
In the event that medical attention is needed, Brooklin Pet Care will make every effort to
contact you or your designated emergency contact. In the event that none of said
emergency contacts are reachable, Brooklin Pet Care will act on the advisement of the
attending veterinarian overseeing your pet’s care to do whatever treatment is
reasonable to keep your pet stable until we can get in contact with you.
If the owner or emergency contact is not reachable within an appropriate time frame,
Brooklin Pet Care, has the authority, on advisement of the veterinarian, to authorize
any medical treatment that is deemed necessary to properly care for your pet, including
surgery, medication, xrays, euthanization.
PLEASE CHOOSE ONE OF THE OPTIONS (This is only if owner or emergency
contact cannot be reached)
DOGS NAME & LAST NAME__________________________
____. Provided treatment of my pet not to exceed $________MINIMUM AMOUNT
$200.00 TO COVER OFFICE VISIT
____.
Please provide whatever treatment is necessary to care for my pet.
SPECIAL INSTRUCTIONS________________________________________________
_____ At the discretion of the veterinarian in charge of my pets’s care, if my pet is
suffering and/or has lost all quality of life, and I or my emergency contact cannot be
reached, I hereby authorize and request euthanasia for my pet.
BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ AND AGREE TO ALL
ITEMS LISTED ABOVE
VISA/MASTERCARD NO. EXPIRY DATE NAME ON CARD
SECURITY CODE
Signature_____________________________Date_____________________________
By not providing my visa no., I understand that treatment will be delayed for my dog
until I can be contacted________________________