Pet Services Agreement Primary Owner*SpouseAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell Phone*Cell Phone (alternate #1)NameCell Phone (alternate #2)NameEmail #1* Email #2 Emergency Contact InformationWe ask that clients provide someone besides themselves who they trust to make decisions for their pets. Our policy in any emergency is to call the contact first followed by the emergency contact if we are unable to reach the ownersContact Name #1*Phone*Contact Name #2PhonePet InformationPet Name*Breed*Sex*FemaleMaleSpayed/Neutered*SpayedNeuteredNot FixedApproximate Weight (lbs)Color*Birth Date (Best Guess)* Date Format: MM slash DD slash YYYY Would you like to add a second pet? YesPet NameBreedSexFemaleMaleSpayed/NeuteredSpayedNeuteredNot FixedApproximate Weight (lbs)ColorBirth Date (Best Guess) Date Format: MM slash DD slash YYYY Would you like to add a third pet? YesPet NameBreedSexFemaleMaleSpayed/NeuteredSpayedNeuteredNot FixedApproximate Weight (lbs)ColorBirth Date (Best Guess) Date Format: MM slash DD slash YYYY Veterinarian InformationVet Practice*Vet Phone*Pre-existing Health or Behavioral ConcernsPet License This is PA state law, but is not required to use our facility services. Apply at padoglicense.comPet License # (only required if PA resident)Annual or Lifetime?AnnualLifetimeAre you a PA resident without a pet license?*YesNoThis is to acknowledge Wagsworth Manor has let you know of the requirement by State law - See Line 13If necessary, you can apply for a license online at Pa Dog LicenseHow did you hear about us?* Friend Veterinarian Family Employee Referral Drive By Web Search Advertisement Former/Return Client OtherThis agreement outlines the terms of your pet's stay (hereafter the term "Pet" shall have either a singular or plural meaning). The Owner and Wagsworth Manor Pet Resort, LLC, hereafter referred to as the "Resort", agree to the following: 1. The Owner hereby certifies to the accuracy of all information given about the "Pet" and understands that in admitting his/her Pet to participate in resort activities, the staff have relied on the representations set forth herein. 2. The Owner specifically represents that the Pet has not been exposed to rabies or distemper and has not been ill with any communicable condition within a 30 day period prior to the receipt of services. 3. The owner represents that his/her Pet has not bitten or shown any aggressive or threatening behavior toward any person, child or animal, except as described below: 4. The owner understands that all Pets are required to have up-to-date vaccinations and are in good health upon check-in. However intestinal and respiratory viruses may not present themselves immediately. Vaccinations are helpful, but not foolproof. Our staff is well-trained to identify health issues. The owner will be contacted immediately if any issues arise. Any medical care costs, related to a pet's illness either during or after boarding, are the responsibility of the owner. 5. The owner understands that Pets, when in groups, can accidentally injure each other while playing or swimming. Minor cuts, scrapes, bite wounds and bruises are possible and not unexpected results of participation in group activities. Provided reasonable care and precautions are followed, the owner understands and releases from liability, the Resort, its staff, agents and assigns, from any problems which arise from attendance and participation in services provided by the Resort. 6. The owner understands that a pet participating in group activities, must be neutered or spayed if over the age of seven months. 7. The owner understands that he/she is solely responsible for any harm caused by his/her Pet, to any person, other Pets, or property while the owner's Pet is a guest at the Resort. 8. If the Hotel staff determines that the Pet requires special handling for safety reasons, the Hotel reserves the right to charge the Owner a daily Manager Only Handling Fee. 9. If Pet becomes ill, or if the state of the animal's health otherwise requires special attention, the Hotel, in its sole discretion, may engage the services of a veterinarian or administer medicine or give other requisite attention to the animal, and the related expenses are the responsibility of the owner. 10. Bathing - if a Pet's stay is longer than 3 days, he/she may receive a basic bath (wash and dry) as deemed necessary by the staff. If a Pet is found to have fleas and/or ticks, he/she will be bathed promptly with flea shampoo. Bathing expenses will be charged to the owner. 11. Grooming - may expose pre-existing health/skin problems for which the Hotel cannot be held liable. De-matting/thinning out of matted hair may cause patchiness and hair loss. Owner understands that any grooming which takes place on an elderly Pet, or Pet with health issues has inherent risks which the Owner agrees to assume. 12. Provided reasonable care and precautions are followed, it is expressly agreed by the Owner that the Hotel's liability shall in no event exceed the sum of $500.00 per Pet. 13. The Owner understands the Pa State Law requires residents to maintain current dog licenses for their Pets over 3 months of age. The State dog warden makes periodic visits to the Hotel and will charge Owner exorbitant fines for non-compliance. 14. The owner gives permission for publication of photos or video taken of Pet and/or Owner by the Hotel. The Owner understands that Owner will not be paid any royalty or other compensation and hereby relinquishes any and all rights for payment if a photo or video of Pet and/or Owner is published in any form or medium. 15. The Hotel will make every effort to return items left with Pet. However these items may not be returned or they may be returned in poor condition. The Hotel is not responsible for said items. 16. The Owner agrees to abide by the Hotel's policies, regarding hours of operation, cancellation fees, vaccination requirements and other operational and safety regulations. 17. The Owner agrees to pay all costs and charges for special services requested, upon pick up of the Pet. The Pet shall not leave the Hotel until all such charges have been paid. 18. This agreement contains the entire agreement between parties. All terms and conditions of the Agreement shall be binding on the representatives and assigns of the Owner and Hotel. This contract shall remain in effect for subsequent transactions between Owner and Hotel. Your Name (Please Type)*Today's Date* Date Format: MM slash DD slash YYYY Signature*CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.