Register DOG BOARDING CONTRACT (12 or 24 hour duration) RM_StatsUsername *Password *Password must be at least 7 characters long.Enter password again *Password must be at least 7 characters long.Email *First NameLast NameMobile NumberHome NumberWork NumberHome AddressLocal Emergency Contact Name/NumberDog 1 NameBreedAgeSex Male Female Neutered YES NO Socialised with others? YES NO Insured? YES NO Name tag? YES NO Date of last vaccinationsKennel Cough YES NO Date of last worming?Date of last Flea Treatment?We advise your worm and flea treat your dog just prior to their stay, to afford them maximum cover, given we are a working farm.Any peculiarities/behavioural issues we should know about?Identichip Number (if applicable)Any continuous medication?*(If yes, please fill out a permission to administer medication form)Dog 2 NameBreedAgeSex Male Female Neutered YES NO Socialised with others? YES NO Name tag? YES NO Insured? YES NO Date of last vaccinationsKennel Cough YES NO Date of last worming?Date of last Flea Treatment?We advise your worm and flea treat your dog just prior to their stay, to afford them maximum cover, given we are a working farm.Any peculiarities/behavioural issues we should know about?Identichip Number (if applicable)Any continuous medication? Name/Address of usual Veterinary SurgeonDo you give consent for us to consult your veterinary surgeon for advice/treatment should we feel your dog(s) need veterinary care whilst staying with us? YES NO OtherIn the extremely unlikely event that a vet recommends your dog(s) be humanely euthanised to prevent further suffering, are you willing to consent to their professional judgement in such cases where they are unable to directly and swiftly contact you for verbal consent? YES NO Do you understand that unless we are deemed negligent for any injury or illness, we will not be held liable for any veterinary fees incurred during your dog(s) stay with us and strongly recommend all pet owners have their own veterinary insurance policy for their dog(s)? YES NO In an emergency, do you give consent for us to seek emergency veterinary care at the nearest vet, even if this is not necessarily your own vet? YES NO Do you give consent for your dog to be transported in our specially equipped dog vehicle for social walks or to visit a vet if required? YES NO We are happy to provide safe, suitable bedding, feed bowls, leads and harnesses, but you are free to bring your own should you feel this would enrich your dog(s) stay. Will you be providing the following?Water/food bowls YES NO Food YES NO Dog Bed YES NO Lead YES NO ToysDoes your dog have any specific dietary requirements/allergies YES NO If yes, please give detailsDry Complete food? YES NO If yes, what is their usual brand?Wet Food YES NO If yes, what brand do you normally feed?Mixer YES NO Country Canines generally feeds a hypoallergenic brand of dog food, Skinners, to our own dogs. We are happy to supply this to any boarding dog, and at times (unless specifically requested not to) we will add a small token gesture of our food to your dog’s meal to tempt them to eat, should they be suffering a loss of appetite initially when settling in with us. Do you consent to your dog having access to our brand of dog food for meals/treats? YES NO SOCIAL INTERACTION/PLAYAre you happy for your dog(s) to mix with others the inside and outside of our home? YES NO Do you use a crate for you dog at any time? YES NO If so, do you give consent for your dog to be crated for periods of time in line with their usual routine? YES NO Please state when you would normally crate your dogs(s)WALKING ON/OFF LEADDo you walk your dog(s) on a lead from their collar or a harness? Harness Collar Either Do you usually allow your dog off lead during their walks across fields/farm land? YES NO Do you have concerns, or history with your dog(s) chasing cats, horses or cattle? YES NO DetailsDo you give consent for your dog to be allowed off lead on our farm during their stay, confident that they will recall safely? YES NO How do you usually recall your dog?Additional InformationOccasionally photographs may be placed on the website or our Facebook page. Do you object to your dog(s) photo going on our website or Facebook page? YES NO CONDITIONS OF BOARDING 1. No booking will be confirmed until this form has been returned signed. 2. In the event of accident, illness, infectious or contagious disease consent is given by the undersigned for a veterinary surgeon to be called for any attention or treatment that is deemed necessary. Vets fees are payable by the animal owner but may be recoverable from our insurance if we are deemed negligent. We do also have public liability insurance. 3. Country Canines reserves the right to walk other dogs at the same time as your dog during it’s stay . The total number of dogs walked at any one time will not exceed 4 on our private premises. 4. Country Canines reserves the right to remove your dog(s) to suitable licensed boarding kennels if your dog(s) displays any aggressive tendencies towards other dogs on the premises or family members. Any fees incurred will be payable by you, the client. A refund in Country Canines fees for the days/nights spent in the care of a licensed boarding kennel facility will be applied to your account. 5. We strongly insist that all pets are fully vaccinated. flea treated and wormed where appropriate, Vaccination for Parvovirus, Distemper, Hepatitis, Leptospirosis and Kennel Cough is strongly recommended for dogs and cats against cat flu, feline enterisis, feline panleucopenia and calicivirus, rhinotrachitis. It is at owner’s discretion and risk if not vaccinated. 6. By law all dogs should wear an identifying tag at all times. During your dog(s) stay with us, for added security, an additional tag with our information will be attached to a collar/harness during walks. EXCLUSIONS Dogs are not accepted for any period of home boarding if not house trained, unless agreed previously. We do not accept uncastrated male dogs above 12 months of age. We do not accept dogs for boarding which have shown any aggression towards ourselves or our own dogs during a familiarisation visit. We insist on the familiarisation visit to check compatibility for home boarding prior to confirming your chosen dates . This visit is free of charge. DROPPING OFF / COLLECTION TIMES We try our best to accommodate your chosen times, but to minimise disruption to the day time routine of our own dogs and family, we ask that dogs be dropped off and collected either before 9.30am or after 3pm Mon – Friday, unless previously agreed. We can offer more flexibility at weekends. CANCELLATIONS: In the event that you fail to notify Country Canines in due course (one week) that your dog(s) does not require our home boarding services, a cancellation fee of 30% of your booking may be charged.I have read and agreed to the above conditions * YES Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
