doggy Intake form please fill this out entirely! Download PDF Form Instead Intake Form OWNER INFORMATION Owner’s Name * Additional Owner Cell Phone * Other Email * Additional Owner’s Phone & Email Home Address * City * State * Zip * Emergency Name (other than owners) * Emergency Phone * Emergency Email * Authorized people to pick up * VET INFORMATION We REQUIRE a copy of current vaccinations from your veterinarian. REQUIRED 1) BORDETELLA 2) RABIES 3) DHP 4) K9 INFLUENZA 5) ANNUAL WELL CHECK & FECAL Vet Clinic(s) This is the vet for: * Veterinary Clinic * Phone * Address * In case of emergency and you are unavailable, maximum $ amount authorized for veterinary service. * plus1 Add Vet minus1 Remove Vet DOG INFORMATION Dog Information Dog's Name * Breed * Dog's Birth Date * * Male Female * Neutered Spayed Neither Description of Dog * Your dog’s health is very important to us. It is important you give us detailed information. All medical conditions (allergies, injuries, chronic): * Precise medication instructions: * Precise feeding instructions: * Flea protection * ALL behavior issues that have been exhibited in the past & present (including biting, growling, food or toy aggression, etc…): * Current behavior concerns: * What frightens or stresses your dog? * To ease anxiety of all of our canine guests, obsessive barkers will be given an all natural, gentle spray collar. Do you use or have any issue with barking / does your dog bark? * Yes No What form of bark control do you use? * May we use your dog’s photo on social media, promotional adds or website for Bend Unleashed? * Yes No Initial * plus1 Add Dog minus1 Remove Dog CANCELLATION & RESERVATION POLICY Your dog’s reservation and room will NOT be guaranteed with out a 3-night deposit. (See website FAQs for the most up-to-date policies.) Holiday’s and summer are our busiest time of year, please plan accordingly with reservations. Daystays require a 24 hour cancellation notice. Boarding require a 72 hours cancellation prior to check in. Holiday boardings require a 14 day cancellation notice. In agreement of being permitted to use the services and facilities of Bend Unleashed I, hereby release, waive, and discharge Bend Unleashed, its owners, staff and volunteers from all liability for any and all loss or damage, and any claim or damages resulting therefrom, on account of injury, loss, damage, infestation, or disease to my dog, including injury resulting in death, whether caused by negligence Bend Unleashed, its owners, staff, or volunteers or otherwise while my dog(s) are under care of Bend Unleashed LLC. I agree to indemnify Bend Unleashed, its owners, staff and volunteers for any loss, liability, damage or cost that may include to my presence or the presence of my dog in or upon Bend Unleashed premises while my dog is under the care of Bend Unleashed. I agree to indemnify Bend Unleashed, its owners, staff and volunteers for any loss, liability and damage, or cost they may incur from delivering my dog from Bend Unleashed premises to and from my place of residence/work. This includes, but not limited to, any injury, illness or death to the dog and damage or theft to my residence/work. I hereby assume full responsibility & financial responsibility for any harm caused by my dog while in or upon Bend Unleashed premises and while my dog is under the care of Bend Unleashed LLC. I further agree to indemnify Bend Unleashed LLC, its owners, staff, and volunteers for any loss, liability, damage, or costs they may incur due to any harm caused by my dogs. I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Oregon, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I further understand and agree that in admitting my dogs to Bend Unleashed, the owners of Bend Unleashed LLC have relied on my representation that my dogs are in good health and have not harmed or shown aggression or threatening behavior to any person or any other pet. I agree that should a court determine that any provision waiving liability is deemed not enforceable, Bend Unleashed LLC liability shall be limited to the funds paid to it by me for taking care of my dogs. I further understand and agree that any injury or illness that develops with my dogs will be treated as deemed best by Bend Unleashed LLC, and that I assume full financial responsibility for any and all expenses involved, even if such expenses were later found to be unnecessary. Furthermore, should my dogs die during our absence, a veterinarian may be called to safe keep my dog’s body until our return. I give Bend Unleashed owners, staff & volunteers permission to discuss any & all medical records regarding my dogs at anytime with all of my dog’s medical teams and Veterinarians. Cancellation Agreement * By signing below, I certify that I agree to accept all the terms, conditions and statements of the Cancellation & Reservation Policy set above. (Typed) Signature of Owner(s) * Date Signed * RULES & REGULATIONS The purpose of Bend Unleashed LLC is to provide a safe, fun and stimulating environment for your dogs. To ensure the safety and health of your dog and all other guests, we require all of our guests to comply with the following... All dogs must be current on ALL vaccinations. Owners must submit written proof FROM THEIR VETERINARIAN that their pet received DHPP, Rabies, Canine Flu, Bordetella & a yearly well check and fecal culture current to date. Specifically, the vaccines required are Rabies, Distemper, Hepatitis, Parainfluenza, Parvovirus, Bordetella and Canine Influenza. These shots are more commonly referred to as DHLPP; 5 in 1 or 6 in 1 and could include or have the kennel cough and Canine flu vaccine as a separate inoculation. These shots are to be given by a Veterinarian annually in addition to rabies every 3 years. All dogs must be in good health. Owners will need to certify that their dogs are in good health and have not been ill in the past 30 days. On admission all pets must be free from any condition, which could potentially jeopardize other guests. Dogs who have been ill with a communicable condition in the last 30 days will require a veterinarian certification of health to be admitted or readmitted. If your dog is turned away because of illness or expired/missing vaccinations, you will forfeit your entire deposit. If your dog does bring in an unnoticed illness you will be held financially liable. All dogs must be non-aggressive to staff. All dogs must have a complete, up to date and approved orientation ($35.00 fee) on file for any group play socialization. All payments must be made in full upon boarding. BOARDING drop-off hours are Monday - Saturday between 3:00pm - 5:00pm BOARDING check-out hours are Monday - Saturday between 7:30am - 12pm DAY STAY drop-off hours are Monday-Saturday: 7:30am -10:30am DAY STAY pick-up hours are Monday-Saturday: 3pm -5:30pm Sunday & holidays, we are closed. WE ARE CLOSED AND WILL NOT TAKE DROP OFFS OR ALLOW PICK UPS BETWEEN 12:00pm to 3:00 pm. All dogs wear a name tag and an appropriate collar. Agreement * By signing below, I certify that I have read and agree to the Rules & Regulations set above. (Typed) Signature of Owner(s) * Date Signed * If you are human, leave this field blank. send form to our staff Where your dog enjoys exceptional care and love while you're busy or traveling Our Instagram Visit us on Instagram! GET IN TOUCH Phone:541-382-9223 E-mail: email@example.com FollowFollow LOCATION Gibson Air Rd. Bend, OR 97701 Our Peacock Lane entrance is permanently closed.Please use our paved entrance via Gibson Air Road.