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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, then can complete it and mail it in with your check or money order. Please write or type your answers in a different color ink – thank you!
Date:
Dog’s Name:
Date of Birth, Breed, Gender, Weight, Color:
Is your dog neutered or spayed?
Owner(s):
Owner Cell & Home Phone:
Address - Street, City, State, Zip:
Email:
2 Emergency Contacts, their relationship to you, Names and Phone Numbers.
If you don’t have a dog will and you want one, contact Carla Bennett, Attorney at Law, 713-629-1580, Ext. 6240 or cbennett @brownsims.com. Carla is a lawyer who has done dog rescue for a decade..
How did you hear about Rummy’s Beach Club, LLC? (Please circle.)
Vet, Friend, Family? (They may get a FREE swim session!)
Saw Rummy’s Beach Club at an Event or Show. Which one? Where?
My kids met Rummy at their School, Library, Church, etc. Where?
Internet Search. Which one?
Magazine Ad. Which one?
Craig’s List _ Kijiji _ Angie’s List _Newspaper _ TV _ Other:
Where and when did you get your dog? (Please circle)…Breeder?....Rescue?….Shelter?…Found?
Veterinarian, Dog Orthopedic Surgeon. Phone. Date last seen?
Dog Acupuncturist, Dog Chiropractor. Phone. Date last seen?
Dog Massage Therapist, Physical Therapist, Trainer, Psychic, Other. Phone. Date last seen?
Your dog’s medicines, vitamins, supplements - dose, how often, reason taking:
List allergies to medicines, flea treatment, ointments, food, etc. and reaction:
List all medical problems, injuries, accidents, date started, treatments, current status:
List all surgeries, injuries or accidents requiring surgery, dates, treatments, current status:
Describe any physical disabilities, emotional or behavioral concerns and how to approach them?
Describe sensitive areas - paws, tail, etc., and his reaction when handled:
Does your dog share food, toys, people or objects with other dogs?
Describe your dog’s behavior when being brushed, groomed or having nails clipped?
When, where, why and at who does your dog growl, snap at, bite or show aggressive behavior?
Bring copies of your dog’s vaccinations or fax them to us before your appointment. He needs:
Rabies (RV) - Annual or every 3 years.
Distemper, Hepatitis, Leptospirosis, Parainfluenza & Parvovirus (DHLPP) Annual or every 3 years.
Bordetella (BV) Twice yearly -protects against Kennel Cough.
Which flea and tick products do you use on your dog, in your home, in your yard and how often?
Does your dog have issues with fleas and ticks despite regular treatment?
Which heartworm preventative do you use? And when was it last given?
Was your dog heartworm positive? Were there complications of treatment?
What kind of training has your dog participated in? (Please circle) _ No training _Trained Yourself
Puppy kindergarten _ Group class: Basic _ Group class: Advanced _ 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:
How much exercise is your dog currently getting? (Please circle)
Daily walk _ Walk 1-3x / wk _ Walk 4-6x / wk _ Dog Park 1-3x / wk _ Dog Park 4-6x / wk
Dog Park everyday _ Daily off leash _ Weekly off leash romp _ Couch potato
Trains 1-3 hrs daily _ Works 5-8 hrs daily _ Trains 1-3 hrs 3x / wk _ Works 5-8 hrs 3x / wk
Other:
Describe your dog's average day. Where is he during the day, where does he sleep at night, what does he do, who does he play with, etc?
Has your dog ever attended daycare? If yes, where, how long, why did it stop?
Do you have children at home? If yes, what are their names and ages?
Do you have other dogs? If yes, what are their names, breeds and ages?
What and how often do you feed your dog - treats, table scraps, bones, dog food, etc. and how often?
How are you hoping your dog will benefit from warm water dog swimming?
Rummy's General Rules. Please Read and Initial In Front of Each Paragraph:
Neutered or spayed dogs are preferred, though not mandatory.
Dogs must be up-to-date on vaccinations.
Dogs with vomiting, diarrhea, no appetite, runny nose, cough, etc. are not welcome.
If your dog gets ill or has been near a dog with an infection, do not bring him swimming for 10 days after exposure or until he is symptom-free for 10 days.
If your dog needs emergent medical attention while at Rummy’s and you are not present, we will contact you and take him to the nearest available veterinarian. Emergency fees are your responsibility.
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:
No food or glass in the pool area.
Cameras & video cameras are welcome.
Dogs participating in warm water swimming should have a referral form signed by your vet, though it is not mandatory.
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.
Keeping Rummy's pool clean with normal shedding is costly and time-consuming. 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. Because Rummy’s pool is outside, appointments may be cancelled or re-scheduled due to inclement weather. If the weather is questionable, please call to confirm your appointment.
DO NOT feed your dog 2-3 hours before and 2-3 hours after swimming. Dogs drink and swallow a lot of air and water while swimming and will regurgitate if they eat too soon before or after swimming.
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 must be closed the entire day and appointments during that time cancelled.
the pool must be cleaned, sanitized and water levels balanced before reopening.
you are responsible for paying for cancelled appointments and pool labor costs.
if your dog defecates more than once in the pool, you may be asked not to return
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.
I have read this RELEASE and understand all its terms. I execute it voluntarily and with full knowledge of its significance. This agreement has no time limit and is valid and enforceable for any and all future activity with my dog[s]. The information provided by me is complete and accurate and I agree to all its terms and conditions.
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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