Bark In The Park: Guest Application

Guest Application

You can either print and fill out the form below then fax or scan it back to us or you can use the online form at the link below.

ONLINE GUEST APPLICATION

Guardian/Owner’s Name__________________________

Address_City_StateZip

Home Phone #( )________Work #( )_Cell#( )

Email Address_

Canine Guest Name____Age_Weight

Breed________________________Gender:_Color_

Yesor NoPet is spayed/Neutered. Adult males and male puppies over 6
months must be neutered.

Dates your pet will be staying with us_to

Preferred drop off time:_Pick up time:___

Veterinarian Hospital_Contact Name and Number

______________________________________________

Address:CityState_Zip

VACCINATIONS: Guardian/Owner is required to provide veterinary proof of current
Rabies, Distemper and Bordetella.

Has your pet ever had a seizure? If yes, please explain what brought it on if
you know. Also please let us know if your pet is currently on medication for seizures.

__________________________

PET’S TEMPERAMENT:

Is your pet frightened of loud noises such as the vacuum cleaner or thunderstorms?

_

Has your pet ever been afraid of any person, growling or trying to bite them?

Is your dog food aggressive? Can you remove food or toys from his/her mouth without
your dog growling or snapping?

Has your dog ever snapped at another dog over toys or food?

Are there any health reasons that you are aware of that would limit your dog’s activities

Has your dog ever escaped, jumping, climbing or digging under a barrier?

______________

Are there any peculiarities about your pet we should know about? For instance, hates
to have his ears touched, etc._

_______________________________

MEDICAL INFORMATION:

Is your pet on any medication?If you will need us to administer any medications,
please list what kind(s), what time of day to give, dosage. Please note that all medications
must be in original bottle. We do not give injections.

Medication:_Give a.m_Give p.m.Dosage

With Or Without a meal.

EMERGENCY CONTACT:

Home Phone#()______Work/ Cell #( )_

PAYMENT METHOD:

Credit Card Type_#Exp.DateCID

Authorized Persons To Drop Off and/or Pick Up Pet

________________

I, the undersigned, hereby acknowledge and agree that all the information provided in this
Guest’s Application is complete and accurate to the best of my knowledge. I further acknowledge
and agree that I have read, understand and agree to all terms and conditions contained in the
waiver of liability, assumption of risk and indemnification agreement as they may be amended
from time to time, which are attached and fully incorporated into this application. I hereby
execute the agreement for my dog, myself and my heirs, successors, representatives and
assigns. I further attest that if I am not the sole owner or representative of the dog subject
to this application, that my signature is sufficient to enter into this agreement for and on
behalf of any other owner or representative.

Customer Signature

Printed Name

Date

DJM Specialties Owner/Employee

Date_

Please contact us with any questions castlemar3@hotmail.com

You can visit us at:
3728 E. FM 4
Cleburne, TX 76031

Please call for an appointment
817-659-5234

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