PET PROFILE

    Name*:
    Breed*:
    Color*:
    Gender*:MaleFemale
    Weight*:
    Spayed/Neutered*:YesNo
    DOB/Age*:
    Please list all behavior issues, if applicable:

    FEEDING INSTRUCTIONS

    Wet Brand:
    Wet Brand Amount (tsp/tbs):
    Wet Brand Feeding Times AM/PM:
    Dry Brand:
    Dry Brand Amount (cups):
    Dry Brand Feeding Times AM/PM:
    Treats:
    Treats Amount (pcs):
    Treats Times AM/PM:
    Additional feeding instructions, if applicable:

    MEDICATION

    Medication Name:
    Dosage:
    Give Times AM/PM:
    Additional Medication Name:
    Dosage:
    Give Times AM/PM:
    Additional medication instructions, if applicable:

    VETERINARIAN INFORMATION

    Veterinarian Name:
    Address:
    Phone:
    Email:
    Please indicate ALL medical/health issues of your pet, if applicable:

    Allergies, if applicable:

    VACCINATION INFORMATION - REQUIRED

    Please attach a copy of current vaccinations for RABIES (1/3yrs), DHPP (1/3yrs), and BORDETELLA (every 6mths) prior to your pet's visit.



    OWNER INFORMATION

    Full Name (first/last)*:
    Spouse/Partner Full Name (first/last)*:
    Address (Street, Apartment, City/State/Zip)*:

    Mobile Number:
    Home Number:
    Work Number:
    Spouse/Partner Mobile Number:
    Spouse/Partner Work Number:
    Email Address*:
    Communication Preference*:EmailPhone
    Weight*:
    Referred by:

    EMERGENCY CONTACT / AUTHORIZATION PICK PICK UP

    Name:
    Relationship to owner:
    Mobile Number:
    Home Number:

    CREDIT CARD AUTHORIZATION

    This website uses a secure certificate to ensure encryption of sensitive data transmitted via the web.
    Name on Card*:
    Billing Address (if different from above):

    Card Type*:VISAMCAMEX
    Card Number*:
    Expiration Date*:
    CCV*:

    GENERAL RELEASE & TERMS

    I, Your Name: , the owner of Pet Name: , am authorized to sign this general release, and agree to the following terms.

    I am responsible for my pet being current on all vaccinations required by the NYC Department of Health, and I understand I must provide MUTT HUTT with current, confirming records from any veterinarian. I also acknowledge that I have disclosed all health issues to MUTT HUTT and that I provide all medications and instructions for administering them to MUTT HUTT. Further, I agree to pay any fines levied by the NYCDOH on MUTT HUTT related to my pet. I understand I am responsible for all MUTT HUTT charges for their services rendered. I agree to provide a current credit/debit card to be kept on file by MUTT HUTT and give my pre-authorization to MUTT HUTT to debit that card for every charge I may incur with MUTT HUTT.

    I agree to indemnify and hold MUTT HUTT and staff from any liability or claim due to injury, loss, pregnancy, or death during or following a stay at MUTT HUTT. I also assume responsibility for any expense or liability for injuries my pet may inflict on a human and/or other animals while boarding with MUTT HUTT.

    I fully understand that my pet is a living creature that may have unknown, underlying health issues and could become ill, injured, and could even die while in the custody of MUTT HUTT. Accordingly, I give consent to MUTT HUTT and their staff to act on my behalf by obtaining veterinary care at my expense if deemed necessary by MUTT HUTT and their staff. I represent that I have provided my veterinarian's most current information. I acknowledge, however, if an emergency arises, MUTT HUTT may have to obtain emergency services from another veterinarian care provider. I understand such risks simply cannot be eliminated, despite the precautions taken by MUTT HUTT and/or by it's staff to ensure that such incidents do not occur.

    I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless MUTT HUTT and its staff from any and all claims, demands, or causes of action which are in any way connected with boarding my pet at MUTT HUTT. I understand that this release does not apply to claims arising from intentional conduct. Should MUTT HUTT or anyone acting on their behalf be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold harmless for all such fees and costs.

    In the event that I file a lawsuit, I agree to do so solely in the state of New York and the City of New York where MUTT HUTT is located, and I further agree that the substantive law of New York State shall apply.

    I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. I further agree that this agreement constitutes the entire agreement between the parties, and that there shall be no oral modifications of any of its terms. I agree to indemnify and hold them harmless for all such fees and costs.

    Pet Owner Digital Signature:
    Signing Date: