Online Reservation Form & Pet Care Release

  ONCE YOU HIT ENTER TO SEND - YOU WILL IMMEDIATELY RECEIVE A CONFIRMATION EMAIL - IF YOU DO NOT RECEIVE CONFIRMATION THEN GO BACK - IT WILL TELL YOU WHAT YOU LEFT BLANK - FILL IN AND HIT ENTER AGAIN.

YOU MUST USE INTERNET EXPLORER

 

*This is a one-time task - all future bookings please call or email at: reservations@diadogclub.com

 

Owner Name(s) Street Address City/State/Zip
Contact Numbers: Home, Work, Cell (Please list names beside each number)
Dates of Boarding- Please indicate both drop-off and pick-up times "YOU MUST CALL TO CONFIRM RESERVATIONS"
Airport Shuttle Requested SHUTTLE TIMES  MON - FRI 7 A.M. - 7 P.M.     SAT & SUN 7 A.M. - 5 P.M.	Yes, my itinerary is below No Airport Shuttle required
Flight Departure Date & Time (AM or PM), Airline and Flight #
Flight Arrival Date & Time (AM or PM), Airline and Flight #
Email Address:
Emergency Contact:
Names of people authorized to drop off/pick up your dog *(Authorized person must show valid I.D. or we will not release your dog to their care)
Dog Name:
Breed:
Birthdate
Color:	Blonde/Golden Black Black & White Brown Brown and White Brown and Black White Tan Tan and White Red Light Red Brindle Multi-colored Blue
Sex:	Male Female
Spayed or Neutered?	Yes No
2nd Dog's Name
Breed:
Birthdate:
Color:	Blonde/Golden Black Black & White Brown Brown and White Brown and Black White Tan Tan and White Red Light Red Brindle Multi-colored Blue
Sex:	Male Female
Spayed or Neutered?	Yes No
3rd Dog's Name:
Breed:
Birthdate:
Color:	Blonde/Golden Black Black & White Brown Brown and White Brown and Black White Tan Tan and White Red Light Red Brindle Multi-colored Blue
Sex:	Male Female
Spayed or Neutered?	Yes No
4th Dog's Name:
Breed:
Birthdate:
Color:	Blonde/Golden Black Black & White Brown Brown and White Brown and Black White Tan Tan and White Red Light Red Brindle Multi-colored Blue
Sex:	Male Female
Spayed or Neutered?	Yes No
Veterinarian Name, Address & Phone # :
Immunization Requirements: It is the responsibility of the client to provide proof of Rabies, Distemper and Bordetella vaccinations for each animal attending DIA Dog Club. Vaccination records must be faxed to 720-207-6889. Dogs whose shots are not up-to-date will not be allowed to attend. The following vaccinations must be up-to-date within 5 days prior to attendance: I have read the vaccination policy.	Yes No
Dog #1 - Rabies Expiration Date:
Distemper Expiration Date:
Bordetella Expiration Date:
Dog #2 - Rabies Exp. Date:
Distemper Exp. Date:
Bordetella Exp. Date:
Dog #3 - Rabies Exp. Date:
Distemper Exp. Date:
Bordetella Exp. Date:
Dog #4 - Rabies Exp. Date:
Distemper Exp. Date:
Bordetella Exp. Date:
Has your dog ever bitten anyone?	Yes No
If yes, explain
Has your dog/s ever jumped a 6 foot high fence?	Yes No
Will your dog/s share toys with other dogs?	Yes No
Has your dog/s ever been with a large dog play group before?	Yes No
Has your dog/s ever exhibited aggressive/possessive behavior towards other dogs, toys, food or people?	Yes No
If yes, explain
Has your dog/s ever been to daycare or boarding?	Yes No
Most recent date of boarding or daycare?
How did you hear about us?	Friend/co-worker Newspaper Internet Search Engine Veterinarian Rescue or Shelter Other
Please list any other information about your dog/s that we should know
CLUB POLICIES: All dogs must be healthy in order to play in group play areas. If ill (diarrhea, vomiting, coughing etc), please notify us so they can be quarantined during their stay. If your pet is not spayed or neutered they may not be allowed in group play areas. All vaccinations current. Proof of vaccinations must be provided.	Yes, I have read the above policies
All dogs must be interviewed before being allowed in group play area. If not socialized, they will be limited to their private run or a private play area, if available. Require a credit card be held on file until services are paid in full.  We suggest reservations.	Yes, I have read the above policies
Safety of the dogs is our first priority. Though we do everything possible to prevent incidents, dog fights can happen and can result in injury. If injuries occur, we will take your dog to the vet and provide you with notification immediately. ** Dog owners are responsible for all medical expenses associated with their respective dog(s).	Yes, I have read the above policies
Owner agrees to conform to and be bound by the policies and procedures of DIA Dog Club LLC. Owner understands that these policies and procedures may be amended at any time. In the event of failure of the Owner or Owner's Dog(s) to conform to such rules, DIA shall have the right to discontinue such rights of Owner's Dog to access DIA Dog Club LLC. I have read the above statement and will initial in the box provided
Date of Signature:
Pet Care Authorization Form (Please place your initials in all boxes)	I will begin reading the policies below I will not visit the policies below
1. DIA Dog Club LLC, its owners, employees, officers, directors and agents will exercise reasonable care for the safety of your pet, and to keep the boarding premises sanitary and properly enclosed. Animals will be fed properly and regularly, and housed in clean, safe quarters. DIA Dog Club LLC, cannot guarantee against accidents, absent negligence on our part, and we cannot be liable for loss or damage by or to animals at this facility.
2. Owner understands and agrees that the Owner is solely responsible for any harm caused by Owner's dog(s) to another dog or to a person while at DIA Dog Club LLC. I agree to indemnify and subrogate DIA Dog Club LLC from any action which may be brought against it, and for any defense, settlement, or judgment against it. Owner will assume all liability for the action of Owner's dog(s).
3. Owner understands the concept of dog daycare/group play and overnight boarding is to allow dogs to be socialized by interacting with people and dogs. Dogs in daycare/group play may toss toys, jump and romp with other dogs. Although these activities are supervised, anytime dogs play together, there is a possibility of injury from rough play or combative behavior.
Owner agrees that any injury to their dog incurred during their use of the facilities shall not bring any liability of any type on the part of DIA Dog Club LLC.
4. Group play is not for dogs that have temperament problems such as aggression or extreme shyness with either dogs or people. If your dog is found to exhibit any of these behaviors they will be removed from the playgroup and Owner will receive a note with an explanation as to why Owners dog was removed. DIA Dog Club LLC has a NO TOLERANCE POLICY. The daily fee will not be refunded for this day of daycare.
DIA Dog Club LLC, is authorized by the Owner to seek veterinary advice or care, including emergency care, at the Owner's expense. If we believe your pet is in need of veterinary care, if time permits we will try to contact you before obtaining that care, but this document serves as our authorization to obtain veterinary care for your pet regardless. The owner is responsible for expenses of veterinary care and transportation, whether or not you have been reached in advance.
The Owner agrees that DIA Dog Club LLC, in its discretion, give medication or other attention when we deem it necessary for the safety and health of the animal.
Standard precautions will be used against the injury, escape, or death of Owner's dog. The staff and management will not be held responsible for injuries that occur, provided standard care and precautions have been followed as determined at the sole discretion of DIA Dog Club LLC.
It is expressly agreed by Owner and DIA Dog Club that DIA Dog Club LLC, liability shall in no event exceed the lessor of the current chattel value of a dog of the same species or the sum of $200.00 (two hundred dollars) per animal. In no event shall DIA Dog Club LLC, be liable for illnesses that arise during Owner's dog stay or after Owner's dog has left the facility. WE ARE NOT RESPONSIBLE FOR KENNEL COUGH.
DIA Dog Club LLC, reserves the right to refuse to accept a dog at Check-In if it appears to us, in our sole discretion, that such dog is sick or that its behavior could jeopardize the health or safety of other pets or our staff.
Owner agrees to pay the rate for boarding and/or daycare in effect on the date the dog is checked into the facility. If any charges are not paid within ten (10) days after invoiced, interest will accrue at 10% per year. Any collection expenses, including attorney fees, shall be paid by the Owner. Owner further agrees that the dog shall not leave the facility until all charges are paid by the Owner. Checkout time is 12:00 PM. Any dog picked up before 12:00 PM will not be charged for the day of pick-up.
Any dog picked up after 12:00 PM will be charged for the day of pick-up. Daycare dogs must be picked up by the close of business. Owner's who are consistently late picking up daycare dogs will be charged $1 per minute late fee. Any dog not picked up within 15 minutes of closing will be placed in boarding facility and owner will be charged additional fees.
This contract is subject to the provisions of C.R.S. 12-64-115 (Abandonment of Animals)	Acknowledged Not Acknowledged
(1) Any animal placed in the custody of a licensed veterinarian for treatment or other care which is unclaimed by its owner or his agent for a period of more than 10 days after written notice, by certified mail, return receipt requested, is given to the addressee only at his last known address shall be deemed to be abandoned and may be turned over to the nearest humane society or animal shelter or disposed of as such custodian may deem proper.
(2) The giving notice to the owner, or the agent of the owner, of such animal by the licensed veterinarian, as provided is subsection (1) of this section, shall relieve the licensed veterinarian and any custodian to whom such animal may be given of any further liability for disposal. Such procedure by the licensed veterinarian shall not constitute grounds for disciplining procedure under this article.
(3) For the purpose of this article, the term "abandoned" means to forsake entirely, or to neglect or refuse to provide or perform the legal obligations for care of an animal by its owners, or his agent. Such abandonment shall constitute the relinquishment of all rights and claims by the owner to such animal.
DIA Dog Club LLC realizes older dogs may experience additional stress in the boarding, daycare, or grooming environment. DIA Dog Club LLC is dedicated to providing exceptional care for your dog, including geriatric animals. Your signature acknowledges that you are aware of any age related risks to your dog. DIA Dog Club LLC does not offer a "Do Not Resuscitate" option for any dog staying at DIA Dog Club LLC regardless of age.
This contract contains the entire agreement between the parties. All terms and conditions of this contract shall be binding on the heirs, administrators, personal representatives and assigns of Owner and DIA Dog Club LLC. Owner recognizes that Owner may give up legal rights by signing "Pet Care Authorization & Release" and knowingly do so as partial consideration for allowing DIA Dog Club to care for my dog.
If my dog dies while in the custody of DIA Dog Club LLC, DIA Dog Club will use reasonable efforts to notify me as soon as possible. DIA Dog Club will take my dog's body to my veterinarian if it is reasonably convenient for DIA Dog Club LLC to do so; otherwise, DIA Dog Club LLC may take my dog's body to Broadview Animal Clinic. Owner agrees to pay any veterinarian expenses immediately upon demand.
Owner may request to have dog transported to and from DIA Dog Club LLC as deemed necessary. The transport service is required to carry all appropriate insurance and Owner agrees to hold DIA Dog Club LLC harmless in the event of injury, accident or death while being transported.
Owner covenants not to initiate legal proceedings of any sort against DIA Dog Club LLC, as a result of injury, illness, death, or damage to Owner's dog arising out of the dog's stay at DIA Dog Club and further agree that, should Owner bring a legal action against DIA Dog Club LLC, the proper result of such legal action should be a summary dismissal in favor of DIA Dog Club LLC, and Owner further agrees to pay DIA Dog Club LLC, including but not limited to, reasonable attorney's fees.
Owner agrees that venue for any action or proceeding filed under this Agreement shall be in Arapahoe County, Colorado.
Owner agrees that by signing the "Pet Care Authorization & Release" one time that it remains in full force and effect each and every time Owner brings Owners dog to DIA Dog Club LLC.
Owner understands and agrees that in the event that any portion of this agreement shall be found void or unenforceable for any reason all other portions of the agreement will remain in fun force and effect.
Cancellation Policy: Should it occur that you must cancel your booking, please do so as soon as possible. Cancellations and No-Shows that take place within 24 hours of drop off date will be charged a non-refundable daily rate. Cancelled and No-Show holiday bookings are non-refundable and will be charged the entire cancelled or no-show stay.
I HAVE READ, UNDERSTAND AND AGREE TO ALL PROVISIONS OF THIS AUTHORIZATION. I fully intend to pickup my dog on the specified date. If circumstances change I will notify DIA Dog Club LLC, of the new pick up time and assume responsibility for any additional charges incurred.
Owner herby waives and releases DIA Dog Club LLC, and their employees from any and all liability for injury or damage resulting from the actions of my dog, any other dog, or any humans in the playgrounds. I expressly assume the risk of any injury to my dog including any and all medical expenses resulting from or relating to said injury, subject to the stipulations set forth in the Authorization above.
I hereby agree to the forgoing as the owner of the aforementioned dog(s). I further certify that my dog(s) is (are) in good health and have not been ill with any communicable condition nor exposed to any communicable disease within the last 30 days. Moreover, I certify to the accuracy of all information given about my dog(s) and that my dog(s) have not harmed or shown aggression or threatening behavior toward any person or animal. I have read and understand the forgoing.
Owner (Owner/Agent for Dog) Signature/Initials
Date:

 

 

 

 

DIA DOG CLUB, LLC

22351 E. Bayaud Ave., Aurora, CO, 80018
6th Pkwy. & E-470 (Big Red Dog House)
303-344-3647 -- Fax # 720-207-6889

www.diadogclub.com