Leominster, MA’s Premiere Dog Walking and Cat Sitting Company

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Dog Owner name ___________________________

Address ___________________________________

Home phone number ________________________

Cell phone number __________________________

Email address ______________________________

Emergency contact if owner not available _____________________________________

Dog’s name ________________________________

Breed _____________________________________

Age ________________

Veterinarian contact information ____________________________________________

How long have you owned your dog? ___________

Is your dog physically fit and capable of participating in walks through The Unbound Hound? Yes ____ No ___

Is your dog up to date with his/her vaccinations? Yes ____ No ____

Please list all of your dog’s medical conditions, dietary issues, and allergies, and any other health-related concerns: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Please list any particular fears your dog has: ______________________________________________________________________________ ______________________________________________________________________________

Are there any other needs or concerns we should be aware of? ______________________________________________________________________________

Has your dog ever bitten or otherwise injured a person, other dog, or other animal? Yes ___ No ___
If yes, please indicate when this occurred and describe the circumstances. ______________________________________________________________________________ ______________________________________________________________________________

Has your dog ever caused serious property damage? Yes ____ No ___ If yes, please describe when this occurred and the nature of the damage. ______________________________________________________________________________ ______________________________________________________________________________
Has your dog ever suffered an injury requiring medical treatment? (such as being hit by an automobile, injured by another animal, etc.) ___ Yes ___No If yes, please describe what happened. ______________________________________________________________________________ ______________________________________________________________________________

I __________________ acknowledge and accept that my dog _____________ (of whom I am the legal owner) will be participating in the dog walking and other related services provided by The Unbound Hound. I understand that these services include other dogs of various ages, breeds and sizes, all in close proximity. The walks may take place in public places including parks, and if I elect this option, may include off-leash play at an enclosed public park with other dogs. These activities may involve encounters with persons who are members of the public as well as other dogs and animals who are not participants in The Unbound Hound’s service. I understand that The Unbound Hound will strive to protect the safety of my dog, but that there are many risks involved that are out of The Unbound Hound’s control. These include, but are not limited to injury or death to my dog caused by another dog or animal, an automobile or other source; provocation of my dog by another dog or animal; injury or death to another dog or animal, or a person, caused by my dog; property damage caused by my dog; ingestion of items causing injury or death to my dog. I understand that it is The Unbound Hound’s goal to provide a safe and fun experience for my dog, but that these inherent risks still exist. I also understand that it is my responsibility to be truthful in completing the above information and disclosing any past history of aggressive behavior which my dog has. On behalf of myself and my representatives, I hereby waive, release, discharge, and agree to hold harmless, defend and indemnify Christina de Andrade, The Unbound Hound, and its owners, managers, members, officers, employees, contractors, agents, assigns, and representatives, from any and all liability of any kind for injuries, losses, damages, claims, demands, arising out of and/or related to my dog’s participation in walking services and other activities at or through The Unbound Hound. In the event of injury or illness involving my dog, I authorize The Unbound Hound to administer CPR or first aid and/or seek medical treatment if it deems this necessary. I agree that I am financially responsible for any such medical treatment. The foregoing information is true and accurate, and I will notify The Unbound Hound if any of the above information changes.
__________________________________________ Dog owner signature Date ____________