Cat Enrollment Form
Please print & fill out 1 form for each cat. When
completed please fax to: 770-599-3329 or email
to: [email protected]
CONTACT & EMERGENCY CONTACT INFORMATION
Cat’s Information
Name: ______________________ Breed: _______________________ Sex: ___________
Age/Birthday: __________________ Color: _____________________ Weight: _________
Owner Information
Last Name: _________________________ First Name(s) __________________________
Address: ________________________________________________________________
________________________________________________________________________
E-Mail Address: ___________________________________________________________
Phone #’s: Cell: ________________ Home: ________________ Work: ________________
Emergency Contact Information
Last Name: _________________________ First Name(s) __________________________
Address: ________________________________________________________________
________________________________________________________________________
Phone #’s: Cell: ________________ Home: ________________ Work: ________________
Veterinarian Information
Practice Name: _________________________ Dr.’s Name(s) ________________________
Address: ________________________________________________________________
________________________________________________________________________
Phone #’s: _______________________________________________________________
Camp Mimi
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Please tell us how you heard about Camp Mimi?
_____________________________________________________________
BEHAVIOR INFORMATION:
Has your cat ever:
Bitten someone? _________________________________________________
If yes, what were the circumstances? _________________________________
Does your cat have any problems in the following areas: (check all that apply)
Escaping ______
Litter box Training___________
Fear of any type person _______
Other (Please explain) _____________________________________________
______________________________________________________________
Is there anything else you would like us to know or do for your cat?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________
Camp Mimi
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Camp Mimi, LLC - Release Form
I, ______________________________, hereby certify that I am the sole owner of my pet,
____________________ (“My Pet”), and have the authority to sign this Registration and Release. I
hereby agree to abide by the following with regard to My Pet and Camp Mimi, LLC (“Camp Mimi”):
1. I certify that My Pet is in good health and has not been ill with any communicable condition in the last
thirty (30) days. I have listed below all of the current medical conditions of My Pet. While My Pet is
enrolled with Camp Mimi, I agree to notify Camp Mimi of any known exposure of My Pet to a communicable
disease. If My Pet is exposed, I will hold My Pet out of Camp Mimi until My Pet is symptom free for a
minimum of ten (10) days or after I provide Camp Mimi with written veterinary clearance that My Pet may
attend Camp Mimi without any risk that My Pet will infect any other pet that attends Camp Mimi. I also
agree to maintain current vaccinations for My Pet as required by Camp Mimi policy. ** Camp Mimi strongly
encourages any pet owner to seek veterinary advice for pets that are obese or have other physical
conditions before attending Day Camp at Camp Mimi**
2. I understand that Camp Mimi does its best to keep the premises at Camp Mimi maintained, sanitary and
properly enclosed. However, I agree that all pets are handled or cared for by Camp Mimi staff and
volunteers without liability on the part of Camp Mimi or its owners, staff or volunteers for loss or damage
from disease, theft, fire, death, escape, injury or harm to persons, other pet(s) or property by said pet(s)
or from other unavoidable causes. I also understand that Camp Mimi reserves the right to refuse in its
sole discretion to allow any dog to attend Camp Mimi for any reason.
3. I further understand that I am solely responsible for any harm caused by My Pet while My Pet is
attending Camp Mimi and assume any and all liability for and agree to pay and hold Camp Mimi harmless for
any expense related to injury to any human or other animal or damage to the Camp Mimi facility or any
other property caused by My Pet.
4. I represent that My Pet has not harmed or shown aggressive or threatening behavior toward any
person or any other pet and I understand that in admitting My Pet, Camp Mimi and its staff have
specifically relied on this representation.
5. I understand and agree that Camp Mimi and its owners, staff and volunteers will not be liable for any
problems, injuries or damages of any type which develop with regard to or that are in any way related to
My Pet. I RECOGNIZE AND ACCEPT THE POTENTIAL RISKS INVOLVED WITH MY PET IN AN
INTERACTIVE DAY CAMP AND UNDERSTAND THAT INJURIES TO MT PET MAY RESULT FROM
THESE INTERACTIONS. Initial’s :(_________)
Camp Mimi
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Camp Mimi, LLC Release Form Continued:
6. I hereby release and agree to hold harmless Camp Mimi and its owners, staff and volunteers from any
liability of any kind or nature whatsoever arising from My Pet attending and participating in activities at
Camp Mimi, other than that resulting from any negligent act on the part of Camp Mimi. I expressly agree
that should Camp Mimi or its owners, staff or volunteers perform any negligent act that causes any injury
or damage to me or My Pet, the liability therefore shall in no event exceed the lesser of the current
market value of a pet of the same age and species as My Pet or the sum of $200.00.
7. I understand and agree that if My Pet becomes ill or injured, or if the state of the My Pet’s health
otherwise requires professional attention, Camp Mimi, in its sole discretion, may engage the services of a
veterinarian or administer medication or give other requisite attention to the pet, and the expenses
therefore shall be paid by me. I consent to allow Camp Mimi and any of its staff or volunteers to act on
my behalf in obtaining emergency veterinary care at my expense for My Pet. I agree to indemnify and
hold Camp Mimi and its owners, staff and volunteers harmless for said expenses.
8. I agree that My Pet may be videotaped, photographed and recorded while attending Camp Mimi. I also
understand and agree that My Pet may be used in any and all media by Camp Mimi for reasons of
promotion, advertising, sale and publicity. I agree that Camp Mimi shall be the exclusive owner of any
proceeds that may be gained by the use of said media.
9. This Release and Registration Form contains the entire agreement between the parties. All terms and
conditions of this contract shall be binding on my heirs, administrators, personal representative and
assigns and those of Camp Mimi. Any controversy or claim arising out of our relating to this contract, or
the breach thereof, or as the result of any claim or controversy involving the alleged negligence by any
party to this contract, shall be settled by a single arbitrator in accordance with the rules of the American
Arbitration Association, and the judgment of the award rendered by an arbitrator may be entered in any
Court having jurisdiction thereof. The arbitrator shall, as part of the award, determine an award to the
prevailing party of the costs of such arbitration and reasonable attorney’s fees of the prevailing party.
10. I understand that reservations at Camp Mimi are required and that My Pet will not be allowed to
attend Camp Mimi without a reservation and current vaccinations. Cancellations with less than 7 business
days (Monday – Friday) notice prior to a reservation will be charged at 50% of the entire fee for the
length of the reservation. Cancellations with less than 3 business days (Monday – Friday) notice prior to a
reservation will be charged the full fee.
11. FEES: I understand that Camp Mimi will collect payment for Day Camp in advance when My Pet is
dropped off. For boarding, Camp Mimi will collect payment in advance at the time My Pet is dropped off.
I understand any additional charges incurred by me for boarding, veterinary services, emergency services,
other services, medications and/or damages for My Pet shall be payable upon my picking up My Pet. Camp
Mimi shall have, and is hereby granted, the right to hold My Pet and I will incur additional charges for
services if I am unable to provide full payment for any and all unpaid charges at the time of pick-up until
payment in full is made to Camp Mimi.
12. I certify that I have read and understand the policies of Camp Mimi as set forth in the preceding
Release and Registration Form and that I have read and understand the conditions and statements of this
agreement.
Camp Mimi
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Camp Mimi, LLC – Release Form Final Page
DAYS & HOURS:
Day Camp:
Monday – Friday
6:30am – 6:30pm
Boarding:
Monday – Friday
Saturday & Sunday
6:30am – 6:30pm
By pre scheduled appointment only
Medical conditions of My Pet:_______________________________________________________
Dated:
_______________________
Signature of Owner:
______________________________
Printed Name:
______________________________
Address:
______________________________
______________________________
Telephone Numbers:
Home: ________________________
Work: ________________________
Cell:
________________________
Representative of Camp Mimi, LLC: ___________________________
Thank you for letting us take care of your pet!
Mimi
Camp Mimi
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