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New Client Form – Warm Water Dog Swimming
We can email this form to you - OR - you can copy and paste this form into a word document, complete it and email it to us prior to your appt.
Date:
Dog’s Name:
Date of Birth, Breed, Gender, Weight:
Neutered or spayed?
Owner(s):
Cell:
Street, City, State, Zip:
Email:
Emergency contact name and phone:
How did you hear about Rummy’s Beach Club, LLC?
Where and when did you get your dog? (Please circle)…Breeder?....Rescue?….Shelter?…Found?
Vet / Surgeon:
Acupuncturist, Chiropractor:
Massage Therapist, Physical Therapist, Trainer, Psychic, Other:
Medicines, vitamins:
Allergies and reaction:
Please list all surgeries, medical problems, injuries, accidents, treatments and current status:
Any physical disabilities?
Any emotional or behavioral concerns?
Does your dog like strangers?
Any sensitive body areas? Paws, tail, etc.?
Does your dog share nicely with other dogs?
When and why does your dog harm / snap / bite / show aggressive behavior toward people or animals?
Please bring proof that your dogs have these vaccines or titers: Rabies (RV) every 3 years, Bordetella (BV) Annually, DHLPP - Annually or every 3 years. (Distemper, Hepatitis, Leptospirosis, Parainfluenza, Parvovirus.)
Flea and tick products you use on your dog, in your home and in your yard:
Does your dog have issues with fleas and ticks despite regular treatment?
Which heartworm preventative do you use?
Ever been heartworm positive? If yes, were there complications of treatment?
What kind of training has your dog participated in? (Please circle all that apply)
No training _ Trained Yourself _ Puppy kindergarten _ Group Training _ Obedience awards
Herding _ Agility _ Flyball _ Dock Dogs _ Show Dog _ Hunting _ Frisbee Pro
Search and Rescue _ Private Training _ Doggie Dancing _ K9 Cop
Service Dog for :
Other:
Daily exercise includes: (Please circle or highlight)
Train Every day Daily walk Walk 1-4x/wk Daily Dog Park Dog Park 1-4x/wk Daily off leash romp in yard Couch potato
Other:
Has your dog ever attended daycare? If yes, why did it stop?
Do you have other dogs? If yes, breeds and ages?
Does your dog enjoy being held and massaged?
What and how often do you feed your dog?
Your dog’s experience in water is…..
How are you hoping your dog will benefit from warm water dog swimming?
Rummy's General Rules. Initial Each Paragraph:
No children under age 14 permitted at Rummy’s.
DO NOT feed your dog 3-4 hours before and after swimming.
No food or glass in the pool area.
Cameras & video cameras are welcome. If you have a season pass, I may take videos and pictures, share them with you on facebook (by tagging you) and then I use them for marketing purposes. If you want a CDs or flash drive of your videos and pictures, there is an extra charge.
Dogs with vomiting, diarrhea, no appetite, etc. are not welcome. If your dog is ill or has been near a dog with an infection, do not bring him swimming for 7 days after exposure. Dogs with vomiting, diarrhea, no appetite, runny nose, cough, etc. are not welcome.
When your dog is outside the gate of Rummy’s, he is required to be on a leash and under control at all times. Observe the 8-foot rule: dogs should be 8 feet or more apart at all times. If your dog is on a retractable leash, keep the length at 4 feet and locked. A slight nudge from a friendly dog has the potential to harm a dog recovering from surgery, a handicapped dog or start a fight with a dog who feels provoked. Not all dogs want to be friends.
Aggressive or out of control dogs and people will be asked to take a time-out or leave.
Rummy's Pool Rules. Please Read and Initial In Front of Each Paragraph:
Please allow 7 days to elapse after you place topical flea treatment on your dog and no lotions, topicals, etc. on dogs prior to swimming - many dogs and people have allergies to these products.
Please brush your dog before swimming. We also appreciate trim and smooth dog nails to minimize skin lacerations and pool scratches.
We take the cleanliness of our pool seriously. We ask you to do the same.
Dogs new to you must live and thrive in good health in your home for 30 days or more prior to swimming.
Cancellations without 24 hour advance notice will incur charges. If the weather is questionable, please call to confirm your appointment.
Please walk your dog before coming to Rummy’s so he can empty his bowels and bladder before getting into the pool and again after swimming. Dogs drink a lot of water while swimming, plus water is a natural diuretic - your dog will need to urinate several times for a few hours after each swim session.
If your dog defecates in the pool:
the pool is closed the entire day and appts cancelled.
the pool is be cleaned, sanitized and water levels balanced.
you are responsible for paying for cancelled appts and pool labor costs.
if your dog has diarrhea – please do not bring him swimming.
Rummy's Legal Stuff. Please Read and Initial In Front of Each Paragraph:
I understand and agree that in admitting my dog to the use of its facility, Rummy’s Beach Club, LLC has relied on my representing my dog is in good health and has not harmed or shown aggressive or threatening behavior towards any person or any other dog EVER, unless I have specified.
I agree to hold harmless and indemnify Rummy’s Beach Club, LLC, and Lisa Goebel, the owner, as well as her agents, employees, volunteers, successors and assigns from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of my dog while in or upon the premises or grounds or near any entrance thereto, and I personally assume all responsibility and liability for such claim.
I further agree to hold the aforementioned parties harmless from any claim of loss of this dog by disappearance, theft, death or otherwise, and from any claim of damage or injury to the dog, caused or alleged to be caused by the negligence of the parties aforementioned, or by the negligence of any other person or any other cause or causes.
I agree that there are inherent risks to me associated with the use of Rummy’s Beach Club, LLC, facilities arising out of or associated with use and conditions, such as swimming, wet floors, multiple dogs and owners and dog behavior. In consideration for Rummy’s Beach Club, LLC granting me permission to use these facilities, I agree to release Rummy’s Beach Club, LLC from liability arising out of or associated with such use, and hereafter waive any and all claims which may arise out of or be associated with such permissive use of the Rummy’s Beach Club, LLC, facilities.
A handling fee of $40.00 will be charged on all returned checks. In the event it is necessary to initiate collection proceedings on the account, Client will be responsible for all attorney’s fees and costs of collection.
Thank you for taking the time to fill out this lengthy paperwork. Please fax or email these papers to us before your first appointment. We look forward to meeting you and your dog and experiencing swimming fun and miracles.
Owner Signature and Date:
Owner Printed Name:
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