Play Therapy Registration

Owner's Information

Name*

First Last

Address*

Street Address City State ZIP Code

Phone Number*

Email Address*

Emergency Contact Person

Other than your veterinarian

Name

First Last

Phone

Relationship

Veterinarian Information

Veterinary Hospital Name*

Preferred Veterinarian:*

First Last

Address*

Street Address City State ZIP Code

Phone

IMPORTANT: Please provide a copy of your animal companion’s vaccination records including proof of a current distemper and rabies with this registration form. Animal companions will not be allowed to attend any programs without proper proof of vaccinations. You may either upload documents using the link below, or email them to woof@greendogsunleashed.org

File

Drop files here or

Max. file size: 256 MB, Max. files: 4.

Animal Companion Personality Profile

Dog's Name*

Breed*

Sex*

Male
Female

Date of Birth*

Is your dog neutered/spayed?*

Yes
No

Color:*

Markings:*

Weight:*

How long have you had your animal companion?*

Where did you get your animal companion?*

If adopted, do you have any information on your animal companion's history?

Please list any training your animal companion has attended in the past:*

What is your animal companion's reaction to childen?*

Which flea preventative do you use?*

When was it last administered?*

Does your animal companion have any health issues that would cause restriction on activities or movements?*

Does your animal companion have any allergies?*

Does your animal companion have any dietary restrictions?*

Does your animal companion go to dog parks?*

If yes, how does he/she get along with the dogs and people there?

What does your animal companion do wen you are not at home?*

Are there any people your animal companion automatically fears or dislikes?*

Are there any animals your animal companion automatically fears or dislikes?*

How does your animal companion react to puppies or small dogs?*

Has your animal companion ever growled or snapped at anyone who has tried to take food or toys away?*

Has your animal companion ever bitten anyone? What happened?*

Has your animal companion ever climbed a fence?*

List several goals that you would like to obtain with your animal companion*

Is there any other information that you think would be helpful?

How did you find out about Green Dogs Unleashed?*

Please include a copy of your dog’s vaccination records including distemper, bordetella, and rabies with this registration form.

The sizes of the classes are limited; contact us by email at woof@greendogsunleashed.org to register for class.

Payments need to be made before first class and can be done by Paypal or mailing check to 1171 North Boston Road, Troy, VA, 22974. Please make checks payable to Green Dogs Unleashed.

Cancellation Policies: We must receive 48 hours cancellation notice if you are unable to attend the class you registered for. If not, we will charge $25 for Administrative Processing. If you drop out of class after the first week of class, we will credit the remaining amount to another class. There will be no refunds.

Payment Policies

NOTE: All checks should be made payable to Green Dogs Unleashed, include in the memo what you are paying for!

TRAINING: Payments must be received no later than one week prior to the start of training classes. All payments must be made either via PayPal to greendogsunleashed@yahoo.com or by cash or checks.

OVERNIGHT ENRICHMENT: Payment for BOARDING should be made by check.

PLAY THERAPY: Play Therapy and Socialization Enrichment programs MUST be paid by check at the time of drop off.

Cancellation Policies: All enrollment fees are non refundable and non transferable, boarding is NON refundable over holiday weeks and must be cancelled a minimum of two weeks prior to a stay for general dates. Play therapy must be cancelled a minimum of 48 hours prior to date or payment is expected.

Green Dogs Unleashed Play Therapy Agreement and Waiver of Liability

This is a contract between Green Dogs Unleashed (herein after called “GDU”) and the animal companion(s) owner (hereinafter called “Owner”) whose signature appears below and checkmark appears by each item and who will be participating in any programs at GDU.

Owner must check the box next to each term.

Classes are at specified times on the training schedule and vary depending on the class. Payment must be received no less than one week prior to the start of the class. Cancellations must be made a week prior to the start of class in order to receive a refund.

To participate in therapy and enrichment programs, animal companion(s) must have passed the required classes. Owner must make an appointment to participate. Drop off times are between 8:00 and 8:30 a.m. Monday thru Friday. Pick up times are between 4:30 and 5:00 p.m. Appointments must be made for drop off and pick up so we can be sure to stagger the animals coming to the facility. A $25 fee will be charged for missed appointments, and frequently missed appointments may result in removal from the program. Late pick up owners will be charged a rate of $25 every fifteen minutes past 5:00 p.m. unless prior arrangements have been made. Please call 48 hours in advance to cancel an appointment to avoid incurring charges. No-shows will be charged $25.

Owner agrees to pay for any and all property damages that animal companion(s) may destroy while at GDU.

Owner agrees to pay any additional charges upon pick up of their animal companion(s) or upon receipt of an invoice in the case of no-shows. In the event of a check returned for insufficient funds or the denial of a credit charge, the client agrees to pay all charges incurred by GDU to collect this debt plus an additional $25.00. Client may then be placed on a cash only account basis based on management’s decision.

Owner specifically represents to GDU that the animal companion(s) has not been exposed to rabies, bordatella (if applicable to species), distemper, or other communicable diseases within any thirty day period prior to participating in programs at GDU, and that all vaccinations are current and will be maintained to include rabies, bordatella (if applicable to species), and distemper. Owner understands that animal companion(s) require a veterinarian certification of health to be readmitted to GDU programs after any illness.

All animal companion(s), over 8 months old, must be spayed or neutered in order to participate in GDU programs unless a veterinarian certificate of health is presented that states it is not in the best interest of the animal companion(s) and why. Final acceptance of the animal is still at the discretion of GDU.

Animal companion(s) arriving with fleas or ticks will be refused services or be bathed, treated with Capstar, and Frontline at GDU if fleas are discovered after the Owner has left. This cost shall be an additional $50.00.

Owner understands that play therapy and socialization programs may include some time in a crate to help with a variety of training needs.

Owner understands that all animal companion(s) must have a properly fitting collar and an identification tag with a phone number of Owner. A microchip is strongly suggested for all animal companions, but not a requirement for program attendance. All animal companions must be on a leash or in a crate when entering or leaving GDU’s facilities.

GDU will not be responsible for any items brought to programs for their animal companion(s) other than food and medications in the case of those animal companion(s) participating in therapy and enrichment programs.

If animal companion(s) becomes ill or if the state of the animal’s health otherwise requires professional attention, GDU, in its sole discretion, may engage the services of a veterinarian, administer medicine or give other requisite attention to the animal, and the expense thereof shall be paid by the Owner. A Medical Release Form must be signed by all participants of GDU programs.

Owners understand that GDU reserves the right to refuse any animal companion from any of its programs. Classes and the Play Therapy and Socialization Programs need to be positive environments and some animal companions may not be suitable. Private training sessions are available for animals with behavior issues that may need some individual training.

By signing this contract Owner certifies to the accuracy of all information given about said animal companion(s) in this document and in the Animal Companion Information Form and Medical Release Form. Owner also agrees to the terms stated in this document, Registration Form, and Medical Release Form all incorporated herein by reference.

GDU shall exercise due diligence and reasonable care for the animal companion(s) participating in GDU programs. All animal companions handled or cared for by the GDU staff or volunteers are without liability on the Facility’s or their staff and volunteers part for loss or damage from disease, theft, fire, death, escape, injury or harm from any other unavoidable causes, due diligence and care having been exercised. The Owner of the animal companion(s) further agrees to be solely responsible and liable for any and all acts or behavior of said animal companion(s) while participating in the programs at GDU.

Owner hereby acknowledges that participation in programs with GDU is voluntary. Owner understands that attendance in GDU programs is not without risk to self, owner’s animal companion(s), any attending guests, family members and owner’s personal property, because some of the other animal companions, as well as the Owner’s animal companion(s), may be difficult to control and may be the cause of injury, damage, or death, even when handled with the greatest amount of care. In consideration for being permitted to participate in the GDU programs , the Owner, on behalf of self, Owner’s heirs, next of kin, executors, and personal representatives hereby unconditionally waive, release, discharge and covenant not to sue GDU, its directors, officers, agents, volunteers, employees, sponsors, organizers, facility/property owners and management, or other representatives, their successors and/or assigns (hereinafter collectively “Releases”),from any and all liability of any nature for any illness, injury, death, damage, or loss that Owner, Owner’s animal companion(s), and anyone attending with Owner may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any animal companion(s), whether or not caused by an ordinary negligent act or omission of the Releases while the undersigned is engaged in or participating in any programs at GDU buildings or the surrounding areas thereto, including but not limited to 1171 North Boston Road, Troy VA, 22974 and all properties and structures adjacent thereto, as well as any other locations where GDU programs may be held as a result of any action by any animal companion(s), including Owner.

Owner specifically represents that he or she is the sole owner of the animal companion(s), free and clear of all liens or encumbrances.

Owner specifically represents that he or she is the sole owner of the animal companion(s), free and clear of all liens or encumbrances.

Client agrees to pay any reasonable attorney fees incurred by GDU to collect any charges incurred by the owner.

Owner agrees that their animal companion(s) may be videotaped, photographed and recorded while they are attending GDU programs. GDU shall be the exclusive owner to the results and all proceeds of such tapings, photography, and recordings with the rights, throughout the world, an unlimited number of times in perpetuity, to copyright, to use and to license to others in any manner. The owner further agrees that their animal companion(s) may be used in any and all media and in the promotion, advertising, sale and publicizing, and exploitation of GDU at no cost to GDU.

Any controversy or claim arising out of or relating to this contract, or the breach thereof, or as the result of any claim or controversy involving the alleged negligence by any party to this contract, shall be settled in accordance with the rules of the American Arbitration Association, and the judgment upon the reward rendered by an arbitrator may be entered in any Court having jurisdiction thereof. The arbitrator shall, as part of his award, determine an award to the prevailing party of the costs of such arbitration and reasonable attorney’s fees of the prevailing party.

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, agents, and assigns of the Owner and GDU. Any part of this contract found to be invalid shall not affect the remainder of this contract, which shall remain in full force. I have read, understand, accept, and agree to be bound by the terms, and conditions of this Agreement.

Animal's Name:*

Owner's Signature (enter your full name):*

Date*

Green Dogs Unleashed Play Therapy Medical Permission Form

(participants please fill out this form in the event something happens during a class/event/play therapy and you need to leave your animal companion with us in an emergency. Thank you.)

Dear Owner:

In the event that our staff or volunteers deem your animal companion is in need of immediate veterinary care, or your animal companion presents with a potential illness and we are unable to contact you, we will take your animal companion to a licensed veterinarian. If your personal veterinarian is located in Fluvanna, VA, we will make every attempt to have your animal companion taken to them. If your veterinarian is unavailable, out of our area, or your animal companion needs immediate emergency care, we will transport to the nearest available veterinary clinic.

I give permission for Green Dogs Unleashed to act as my agent in the event of my animal companion needing medical attention. I further agree that I will be responsible for any and all cost of any veterinary care deemed necessary by the licensed veterinarian.

Owner's Signature (enter your full name):*

Date*

Day Time Phone #*

Cell Phone #

Animal Companion's Name:*

Regular Veterinarian*

First Last

Phone #*

We recommend that you call your regular veterinarian to let them know your animal companion will be in the care of Green Dogs Unleashed.

Comments

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