Broadmore Kennels Boarding Contract
Phone: 913.441.5026
Fax: 913.441.5309

 
Owner Information
Date:
Owner's Name:    New Client?  Yes No
Address:
City:   State:   Zip:
Phone Numbers  
  Home: Work:
  Cell: Fax:
Email Address: REQUIRED
  How did you hear about us?
 
Customer's Responsibility To Provide Proof Of Vaccinations (Prior to check-in)
1st Dog   2nd Dog   3rd Dog  
Name: Name: Name:
Breed: Breed: Breed:
Color: Color: Color:
Sex: Male Female Sex: Male Female Sex: Male Female
  Spayed/Neutered?   Spayed/Neutered?   Spayed/Neutered?
DOB DOB DOB
 
Veterinarian Information 
Name:
Phone Number: Fax:
     
EMERGENCY Information 
Contact: Phone:
Relationship:
Contact: Phone:
Relationship:
 
Dog(s) Profile
Dog's Name:    Last Name:
1) Spayed or Neutered? Yes   No
2) Where did you get your dog?
3) If adopted, do you have any past history information?
4) Are you aware of your dog ever being abused by anyone?
5) Is your dog around children? Yes   No
How do they behave?
6) Are there any other animals in your household? If so, please list type, sex and age, and describe how your dog interacts with these siblings.
7) Do you take your dog to the dog park or any other type of off leash area? Yes   No
How does your dog behave in these environments?
8) Do you consider your dog good with other dogs? Yes   No Siblings Only
Explain:
9) Has your dog ever been attacked by another dog? Yes   No
If yes, please explain:
10) Describe your dog's Temperment:
11) Does your dog have a history of biting? Yes   No
If yes, please explain:

Please be honest with the information you provide. This information will be used to better understand the needs of your dog.

For example, if your dog has previously bitten someone, it does not automatically mean that we will not board your dog.

It means we need to understand the circumstances surrounding the event, so we can insure we provide a positive experience for your dog.
12) Does your dog have any other behavioral issues that we need to be aware? Such as, housetraining; jumping; barking; digging, etc. Yes   No
If yes, please Explain:
 
Please list any additional special instructions for your dog:
 
Health
Owner must provide Prescription Foods or any other special diet other than what is provided by Broadmore Kennels.
Presciption Food:  Purpose:
Feeding schedule: AM  PM Self-Feed
Special instructions:
SPECIAL MEDICAL CONDITIONS? Yes   No
If yes, please explain:
ALLERGIES? Yes   No
If yes, please explain:
MEDICATION? Yes   No If yes, please describe:
Name of Medicine:
Purpose:
Dosage:
Name of Medicine:
Purpose:
Dosage:
Name of Medicine:
Purpose:
Dosage:
   

BOARDING POLICIES & RELEASE

CLIENT AGREEMENT

For myself, my heirs, and any assigns, I hereby release Broadmore Kennels, Inc., it agents, officers, subcontractors, employees, animal owners, customers and potential customers of Broadmore Kennels, Inc., from any and all liabilities for injuries to myself, my dog, or any other property of mine which arise in any way out of services and/or products provided by or as a consequence of my association with Broadmore Kennels, Inc. I acknowledge and understand that there are certain risks involved in dog ownership, training and care, including but not limited to dog fights, dog bites, to humans or other dogs and the transmission of diseases. With my submission of this form I acknowledge and accept exclusive and sole responsibility for these and all other risks and release Broadmore Kennels, Inc., of all liability, no matter the cause.

PERSONAL ITEMS

We welcome personal items, which provide your loved one the scents of home. We ask that all items are labeled and please do not bring any items that have sentimental value. While we do everything in our power to keep these articles safe, clean, and with your pet for their intended use, WE WILL NOT BE HELD RESPONSIBLE FOR ANY ITEM(S) WHICH BECOME LOST OR DESTROYED.

RESERVATION CANCELLATION POLICY

We are more than happy to accommodate your reservation request. Please remember that we are holding your reservation request pending your pet’s arrival. Many times customers forget that our facilities are limited and that when we become full we have to turn business away. Due to an unmanageable increase in “No Shows” and late cancellations, we have been forced to implement the following policy:

Memorial Day thru Labor Day, and Major Holidays are considered PEAK Season Months. During these times, a NON-REFUNDABLE deposit will be required in the amount of $50.00 or 50% of the amount of stay, whichever is less in value. However, the deposit will be applied to your stay, or forfeited if for any reason you cancel or do not show for your reservation. At management discretion a non-refundable deposit may be requested non-dependent upon seasonal requirements.

Also, my submission of this form, I hereby authorize Broadmore Kennels, Inc., to obtain medical and/or treatments for my dog(s) in the event of illness and/or injury from the veterinarian listed above or the closest Veterinarian Clinic/Hospital and by this document do hereby direct said Veterinarian to provide those records. I understand that full payment is expected upon pickup.