Downtown Dog Lounge | Pet Profile for Downtown Dog Lounge

1. Effectiveness. The Animal Medical Power of Attorney shall become effective in the case of medical emergency requiring immediate care for my pet during my absence or if deemed necessary to preserve the life or well being of my pet.

2. Powers. By the execution of this Animal Medical Power of Attorney, it is my intention that my attorney-in-fact shall have authority to make all emergency healthcare decisions for my pet to the same extent I would, including but without limitation, the following: to employ and discharge medical personnel; to execute documents; to provide written consents/releases for treatment; to obtain and administer prescribed medications; and to incur reasonable and necessary fees and costs in carrying out the powers and duties under this document that shall be reimbursed by me upon my demand by DDL.

3. Indemnification. I shall hold harmless and indemnify my attorney-in-fact from all liability for acts done in good faith.

Assumption of Risk, Release and Indemnification
1. Assumption of Risk. I understand and acknowledge that pets can be extremely unpredictable in behavior and while DDL performs its services, the chance of injury to my pet is possible. I assume all risks related to DDL’s services to my pet (with the exception of gross negligence of DDL), including but not limited to: illness, bodily injury; death; theft; bites; collisions with vehicles; natural disasters; the unavailability of emergency medical care; or the negligence or deliberate acts of third parties.

2. Release of Liability. I agree not to sue and to release from liability DDL, its officers, owners, agents, employees and other persons or entities involved with the services offered by DDL, from all actions claims or demands for injury, loss or damage regardless of the cause.

3. Indemnification. I understand and acknowledge that pets can be extremely unpredictable in behavior and may cause damage to third parties for which DDL could be held liable. I agree to bear any and all damages, losses, liabilities, demands and expenses, including legal and professional fees DDL may incur as a result of any damage caused by my pet, and I agree to defend, and hold DDL harmless for any liability thereon.

I understand that this Agreement contains an Animal Medical Power of Attorney, release of liability and contract between DDL and me and I am signing this agreement of my own free will. If any part of this Agreement is deemed unenforceable, all parts shall be given full affect to the extent possible. If there is a dispute between the parties relating to this Agreement, the party substantially prevailing will be entitled to recover all costs and expenses of any subsequent proceedings (including trial, appellate and arbitration proceedings), including the attorney fees incurred therein. This Agreement contains the complete understanding of the parties with respect to the subject matter hereof and supersedes all prior presentations and understandings, whether oral or written. This Agreement may be modified only by writing and signed by both parties.

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Are you a new customer or updating information? New Customer Updating existing information
Customer Information
First Name:			Last Name:
Street Address:			City:
State:			Zip Code:

Email Address:			Home Phone Number:
Cell Phone Number:			Work Phone Number:
Would you like to receive email updates of our policies, pricing, and newsletters with discounts and special offers? (8-10 emails per year total.)			YesNo
Emergency Contact:			Emergency Contact Phone:

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General Information
Dog's Name:			Gender	MaleFemale
Breed:			Fixed?	YesNo
Birthdate:			Microchip #:
Weight:			Color:
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Most Recent Vaccination Dates (Proof required at evaluation) We require that you bring proof of DHPP, Rabies and a 6 month Bordatella.
Rabies:			Bordatella:
DHPP (Distemper/Parvo):
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Medical Information
Vet Clinic:			Doctor:
Vet City:			State:
Vet Phone:			Vet Fax:
Medication, dosage:
Medication, dosage:
Known Allergies:
Surgeries:
Chronic Ailments:
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Feeding Directions While Lodging at DDL
Breakfast:	Lunch:	Dinner:	Amount at each meal:	Type of Food:

Special Food Instructions:		Additional Instructions:
If we run out of your dog food during your dogs stay, can we feed them DDL food?				YesNo
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Walking Directions
Special Collar or Leash? If so, type:
Are city walks OK?	YesNo		Are off-leash dog parks OK?	YesNo
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Where did you get this dog?			When did you get this dog?
Training types/dates:			Commands mastered:
Where does this dog sleep?			Behavior at dog park (plays, aloof, shy, etc?)
Has this dog ever bitten another dog or person? If yes, please explain:

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How did you hear about us?
If your dog becomes ill or injured, where do you want us to transport him/her, or whom do you want us to call?
I understand that I am financially responsible for any damage to DDL facilities and equipment caused by my dog. (Please initial)
I understand that if I do not pick up my dog by closing time, he/she will be fed dinner and provided overnight accomodations, and appropriate boarding charges will apply. Hours are 7am - 7pm, Monday-Friday and 8am - 5pm on Saturday and Sunday. (Please initial)
I have read and understand "Are You Ready For Dog Daycare" and understand that dog daycare has some risks along with its many rewards. (Please initial)
All dogs are required to complete an on-site evaluation prior to attending daycare or boarding. Which location would you like to have your evaluation performed?	Capitol Hill (420 E Denny) Elliott (1405 Elliott Ave)

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Animal Medical Power of Attorney Downtown Dog Lounge will make every effort to contact you in the event of a medical emergency involving your pet. However, if we should be unable to reach you, we will need formal authorization to request care for your pet on your behalf. Please review the following Animal Medical Power of Attorney, and if acceptable, sign below. I, the undersigned owner, hereby designate Downtown Dog Lounge LLC, DDL Urban Dog Retreats LLC (“DDL”), to act as my attorney-in-fact and to act in my name for the emergency medical benefit of my pet upon the terms and conditions outlined below. 1. Effectiveness. The Animal Medical Power of Attorney shall become effective in the case of medical emergency requiring immediate care for my pet during my absence or if deemed necessary to preserve the life or well being of my pet. 2. Powers. By the execution of this Animal Medical Power of Attorney, it is my intention that my attorney-in-fact shall have authority to make all emergency healthcare decisions for my pet to the same extent I would, including but without limitation, the following: to employ and discharge medical personnel; to execute documents; to provide written consents/releases for treatment; to obtain and administer prescribed medications; and to incur reasonable and necessary fees and costs in carrying out the powers and duties under this document that shall be reimbursed by me upon my demand by DDL. 3. Indemnification. I shall hold harmless and indemnify my attorney-in-fact from all liability for acts done in good faith. Assumption of Risk, Release and Indemnification 1. Assumption of Risk. I understand and acknowledge that pets can be extremely unpredictable in behavior and while DDL performs its services, the chance of injury to my pet is possible. I assume all risks related to DDL’s services to my pet (with the exception of gross negligence of DDL), including but not limited to: illness, bodily injury; death; theft; bites; collisions with vehicles; natural disasters; the unavailability of emergency medical care; or the negligence or deliberate acts of third parties. 2. Release of Liability. I agree not to sue and to release from liability DDL, its officers, owners, agents, employees and other persons or entities involved with the services offered by DDL, from all actions claims or demands for injury, loss or damage regardless of the cause. 3. Indemnification. I understand and acknowledge that pets can be extremely unpredictable in behavior and may cause damage to third parties for which DDL could be held liable. I agree to bear any and all damages, losses, liabilities, demands and expenses, including legal and professional fees DDL may incur as a result of any damage caused by my pet, and I agree to defend, and hold DDL harmless for any liability thereon. IT IS THE INTENTION OF THE PARTIES TO THIS AGREEMENT THAT THE FOREGOING RELEASES SHALL BE EFFECTIVE AS A BAR TO ALL ACTIONS, FEES, DAMAGES, LOSSES, CLAIMS, LIABILITIES, DEMANDS OR DEBTS WHATSOEVER, OF ANY NATURE OR KIND, KNOWN OR UNKNOWN, SUSPECTED OR UNSUSPECTED, ARISING OUT OF THE PERFORMANCE OF DDL’S SERVICES. THE PARTIES TO THIS AGREEMENT EXPRESSLY CONSENT THAT THIS RELEASE SHALL BE GIVEN FULL FORCE AND EFFECT IN ACCORDANCE WITH EACH AND ALL OF ITS EXPRESS TERMS AND PROVISIONS. I understand that this Agreement contains an Animal Medical Power of Attorney, release of liability and contract between DDL and me and I am signing this agreement of my own free will. If any part of this Agreement is deemed unenforceable, all parts shall be given full affect to the extent possible. If there is a dispute between the parties relating to this Agreement, the party substantially prevailing will be entitled to recover all costs and expenses of any subsequent proceedings (including trial, appellate and arbitration proceedings), including the attorney fees incurred therein. This Agreement contains the complete understanding of the parties with respect to the subject matter hereof and supersedes all prior presentations and understandings, whether oral or written. This Agreement may be modified only by writing and signed by both parties.