dog walking booking form - whitehill information systems · 2012-12-09 · treatments. your dog...
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Dog Walking Booking Form
Please complete all details in BLOCK CAPITALS
Dog’s Name
Owner’s Details
Name _____________________________________________________________________
Address _____________________________________________________________________
____________________________________ Postcode ___________________
Daytime Number _____________________________________________________________________
Mobile Number _____________________________________________________________________
Evening Number _____________________________________________________________________
Email address _____________________________________________________________________
Dog’s Details
Breed ________________________________________ Gender: Dog Bitch
Size Small Medium Large Extra Large
Colour ___________________________ Date of Birth: _____________ Age: _____
Inoculation Date ___________________________ Micro Chipped: Yes No
Allergies ___________________________ Neutered/Spayed Yes No
Emergency Contact Details (please provide at least two numbers)
Contact One _____________________________________________________________________
Contact Two _____________________________________________________________________
Veterinary Surgeon
Name of Practice _____________________________________________________________________
Address _____________________________________________________________________
Telephone Number _____________________________________________________________________
Further Details
Does your dog pull excessively on the lead? Yes No
Does your dog react aggressively, nervously, or in a negative way to any of the following?
Other dogs Yes No Small animals Yes No
Traffic Yes No People/children Yes No
Horses Yes No Joggers/cyclists Yes No
Livestock Yes No Loud noises Yes No
Please state any notable/adverse reactions related to the above question
_______________________________________________________________________________________
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Please indicate if your dog has any issues with dominance or possessiveness over toys/food/people/other dogs?
_______________________________________________________________________________________
_______________________________________________________________________________________
Does your dog have any problems travelling in a car? Yes No
If Yes please give details (overleaf) of how they are used to travelling e.g. cage/boot/with seatbelt harness.
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Will your dog come back immediately if called: Yes No
Please provide details of any special re-call word or sign your do understands (e.g. clapping, whistling etc.)
_______________________________________________________________________________________
_______________________________________________________________________________________
Are you happy for Faye Lawrence or Ian Humphreys to walk your dog on occasions when I can not?:
Yes No
Insurance Details
Is your dog insured? Yes with ________________________________________ No
Other Details / Further Comments
Please add any further details you may feel relevant
_______________________________________________________________________________________
_______________________________________________________________________________________
Walking Off The Lead
I hereby give authority for Sally Smith to let my dog off the lead, once they are comfortable that my dog knows and trusts them and will return when called. Yes No
Terms and Conditions
• The owner will ensure that their dog is clean, with up-to-date vaccinations, de-flea and anti-worm
treatments. Your dog must wear an identity disc on their collar as it is illegal not to do so.
• The owner undertakes to make full disclosure of any quality or characteristic which might make your dog unsuitable for dog walking, including behavioural or health problems and antisocial behaviour
including aggression. Failure on the part of the owner to disclose any matter, which might render the owner’s dog unsuitable for dog walking, will be deemed a material omission amounting to a fundamental breach of our agreement.
• All efforts will be made to contact the owner in the event of an emergency. However, we reserve the right to make decisions regarding your dog’s health provided it is at all times acting in the best
interests of the dog and on the advice of a veterinary surgeon.
• The owner is responsible for payment of any veterinary fees incurred by us.
• The owner accepts full liability for any loss or damage caused by the dog whilst being walked.
• 24 hours’ notice is required for single cancellations and 1 week’s notice for permanent cancellations.
In the event of notice not being given the full fee will apply for each walk missed.
• For regular users invoices will be issued on a monthly basis. For occasional users invoices will be issued weekly. Payments due must be paid within 7 days of invoice.
• The owner accepts that occasionally circumstances (e.g. illness, holiday or similar) will mean that Sally
Smith will be unable to visit or walk your dog/pet, unless another suitable alternative attendant or walker can be provided.
• Two keys/sets of house keys will be required.
I hereby confirm that I am the owner of the above mentioned dog and that the above details are correct. I further confirm that I will be responsible for all costs incurred either veterinary or other as a result of sickness, accident or damage caused to or by the above mentioned dog, except third party liability. I will ensure that I will notify you of any changes to this information should any become apparent following the submission of this form. I also appreciate that it is my responsibility to update you as and when required.
PRINT NAME __________________________________________________________________________
SIGNATURE ___________________________________ DATE _____________________________
Payment details: Ms S J Smith t/a Doggy Services 4U. Barclay Bank 20-41-12 a/c No. 43664120. Please use bank transfer if possible and add your dog’s name as the transaction reference. Thank you.