Play Date Form

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Daycare Waiver and Consent Form

This agreement shall apply to all boarding or daycare visits by your pet(s) to
FloridaWild Veterinary Hospital (“the facility”).

Please initial next to every point to indicate that you have read and
understand.

Ownership

I represent that I am the legal owner or authorized representative of the owner for the pet(s) described on this document*

Please Initial

Vaccines/Medical History

I represent that my pet(s) is/are in good health, is/are current on all required vaccinations (Dogs – DHPP, Rabies, and Bordetella; Cats – FVRCP and Rabies), or vaccine titers, and have had a negative fecal test within the past 12 months.*

Please Initial

I understand that while my pet(s) is/are fully vaccinated, vaccines are not guaranteed, and there is a small risk that my pet(s) may contract a contagious disease or illness (such as Canine Influenza or Bordetella/Kennel Cough in dogs, upper respiratory infections in cats). I agree that should this occur, I am responsible for my own pet’s care, medical attention, and the associated costs.*

Please Initial

I represent that my pet(s) is/are free of fleas, ticks, and lice and has/have not been ill within the past 30 days.*

Please Initial

I understand that should fleas or ticks be observed on my pet(s), a flea/tick treatment will be applied to my pet(s), and I will be responsible for any associated charges (cost is dependent on the size of pet, species, and severity of infestation).*

Please Initial

I agree to disclose any previous or current medical issues/concerns for my pet(s) so that the facility’s staff can decide on suitability for daycare/boarding.*

Please Initial

Medications

I understand that the facility’s staff are not veterinarians and must follow strict
guidelines when administering medication to my pet(s). Medication will be
administered according to the dosage prescribed on the medication bottle, and the
facility will not deviate from the prescription. All prescriptions must be presented in
the original pharmacy container and have a label that includes:

1) the owner’s name, 2) the pet’s name, 3) the drug name, 4) the dosage, 5) the veterinarian’s name, 6) the veterinarian’s contact information (address/phone number), and 7) the date the medication was issued.*

Please Initial

Risks

Dogs – I represent that my dog(s) is/are social and has/have not harmed or shown threatening behaviors towards any person or other dogs. I understand that the facility reserves the right to remove my dog(s) from the play area and place my dog(s) in a separate holding area should my dog(s) display any unwanted behaviors.

Please Initial

Dogs and Cats – I understand that if my pet(s) act aggressively toward another pet or the facility staff, resulting in injury to the pet or staff, I will accept responsibility for any veterinary care needed on behalf of the injured pet or any medical care needed on behalf of the staff member as a direct result of my pet(s) actions.*

Please Initial

I understand that special-needs pets, young pets, and senior pets naturally have a higher risk of injury, stress-related illnesses, weakened immune systems, or exacerbation of any pre-existing condition, and am waiving any claim for injury or illness experienced by my pet while in the care of the facility*

Please Initial

I understand that if my pet is elderly (approaching end of life) and unexpectedly passes while in the facility’s care, he/she will be held until I can be reached for further instructions.*

Please Initial

I give permission for the facility to bathe my pet if he/she soils his/her fur (feces or urine) while in the care of the facility and understand that additional costs will be incurred (up to $100 depending on size and disposition of pet).*

Yes

I wish to decline this service

I give permission for the facility’s staff to contact my veterinarian for records should any injuries or illnesses occur that require medical attention, and I agree that I am solely responsible for any medical expenses incurred on behalf of my pet(s).*

Please Initial

Intact Pets

Daycare – I understand that if my pet(s) is/are over the age of 7 months, is/are not spayed or neutered, and is/are exhibiting “intact” behaviors or signs of a heat cycle, that I will be immediately contacted by the facility for pick-up*

Please Initial

Additional Facility Policies

I understand cancellations must be made 48-hours prior to the reservation date, or I may be charged a fee for failure to cancel timely*

Please Initial

I understand that the facility reserves the right to refuse admittance to any pet(s) that does not meet or maintain the health, temperament, or other daycare/boarding standards. The determination shall be made at the sole discretion of the facility*

Please Initial

I understand that payment in full is due at the time of pick-up*

Please Initial

If myself or my authorized representative cannot pick up my dog(s) at the agreed pick-up time, I authorize the facility to provide additional overnight and daycare services at my own expense.*

Please Initial

I understand that daycare hours are from 7:30 am to 5:30 pm, and if I pick up my dog(s) late, I may be charged an after-hours staff fee.*

Please Initial

Media Release

I understand that the facility may, from time-to-time post photos or videos of pets on Facebook, our website, and/or other marketing materials. I agree to allow the facility to use my dog’s name(s) and any images or likeness of my dog(s) taken while he/she is at the facility, in any form, for any use at any time, in any media, marketing, advertising, illustration, trad or promotional materials without compensation, and I release to the facility all rights that I may possess or claim to such image, likeness, recording, etc.*

Please Initial

Liability Release

I understand and agree that during normal play, my pet(s) may sustain injuries. While social/group play (dogs) is monitored by the facility staff in an effort to avoid injury, scratches, punctures, torn ligaments, and other injuries may occur despite the best supervision. I understand and agree that neither the facility nor any of the employees/staff will be liable for any illness, injury, death, and/or escape of my pet(s), provided that reasonable care and precautions are followed, and hereby release the facility and employees/staff of any liability whatsoever arising from or as a result of my pet(s) receiving services from the facility*

Please Initial

I fully understand and agree to the terms of this Agreement as of today and that such terms will become effective on the first date of service and will continue for an unspecified period of time applicable each and every time I bring my pet(s) in for services at the facility.*

Please Initial

Signature of Owner*

Date*

Printed Name of Owner*

Contact Phone Numbers*

Medical Release Form

This is a required form for all FloridaWild Veterinary Hospital participants receiving
services.

First and foremost, the safety and well-being of your pet(s) is most important
to us. Ensuring that your pet remains safe and well cared for is our first
responsibility, and as such, we take it very seriously. We do our best to have our
pet parents screen for pre-existing health conditions, but some factors may be
beyond our control. If a pet appears ill, injured, or exhibits any other behavior that
would reasonably suggest that the pet needs medical treatment (including
anesthesia) while at our facility or participating in a service that we provide, it is
recommended that we provide care as quickly as possible. For that reason, it is a
requirement that our pet parents authorize how they would like us to proceed in an
emergency situation on this medical release form.

In the event of an emergency, I would like to be contacted but DECLINE emergency medical intervention and will take my pet/s to the veterinarian of my choosing. I understand that this will prohibit the FloridaWild staff from providing any care to my animal, regardless of the nature of the incident.

Please Initial

In the event of an emergency, I authorize emergency medical intervention by any veterinarian on staff at FloridaWild Veterinary Hospital.*

Please Initial

If medical care was authorized above, I understand that in the event of a medical emergency, FloridaWild Veterinary Hospital has sole discretion to provide immediate medical attention from any of our licensed veterinarians if deemed necessary for the welfare of my pet(s). I further acknowledge that I will be financially responsible for any medical treatment(s) required by my pet(s) as a result of the medical emergency while my pet(s) is/are receiving services provided by FloridaWild Veterinary Hospital. If FloridaWild Veterinary Hospital is unable to reach me or one of my authorized representatives prior to starting the medical intervention, I approve veterinary care costs for my pet(s) up to the amount stated below and and understand that if the necessary veterinary care exceeds this amount, additional recommended services may be postponed until contact has been established.*

Please enter amount

Signature of Owner*

Date*

Printed Name of Owner*

Contact Phone Number*

Additional Emergency Contacts (Authorized Representatives for Owner)

Name

Phone

Name

Phone

Pet and Veterinary Information

Pet Name*

Age*

Sex*

Male

Neutered Male

Female

Spayed Female

Breed*

Any known health conditions

Would you like to add a second pet?

Yes

Second Pet Information

Pet's Name*

Age*

Sex*

Male

Neutered Male

Female

Spayed Female

Breed*

Any known health conditions

Would you like to add a third pet?*

Yes

Third Pet Information

Pet Name*

Age*

Sex*

Male

Neutered Male

Female

Spayed Female

Breed*

Any known health conditions

Pet Veterinarian Information

I give full authority to the facility and the facility staff to request and retrieve
veterinary medical records for my pet(s), as listed herein, and release Veterinarian
from any liability for the release thereof.

Signature of Owner*

Date*

Printed Name of Owner*

Name of Veterinarian*

Address of Veterinary Office*

Street Address

Address Line 2

City

State

ZIP Code

Phone Number of Veterinary Office*

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Daycare Waiver and Consent Form

Ownership

Vaccines/Medical History

Medications

Risks

Intact Pets

Additional Facility Policies

Media Release

Liability Release

Medical Release Form

Additional Emergency Contacts (Authorized Representatives for Owner)

Pet and Veterinary Information

Second Pet Information

Third Pet Information

Pet Veterinarian Information

What's Next

Call us or Schedule an Appointment Online

Meet With a Doctor for an Initial Exam

Put a Plan Together for Your Pet

Where family pets find loving care