Client Registration
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Boarding Release Form

To avoid potential hazards, your pets collars and leashes will be removed and returned to you when your pet is dropped off for boarding. For sanitary and parasite control reasons, we provide all bowls and bedding which we wash in hospital.  We do provide towels and blankets for our boarding canines to keep them comfortable. If your dog has a bed that needs to be with them for a medical reason, we will accommodate it but we cannot accept any responsibility for loss or damage. We do not have the capability of cleaning dog beds.  Our feline friends that board with us will be provided blankets and cushions for their comfort. 
** Dogs are walked & exercised in our yards 3 times per day Mon-Sat and 2 times per day on Sunday. Additional walks are available Mon-Fri for $10 per day (excluding holidays). Dogs with boarding reservations that include additional walks are walked 5 times per day.** 
** If your pet boards for 5 nights or longer with us you are entitled to a bath at 1/2 price (including ear cleaning and nail trim**
 
Currently, our boarding prices are the following:
 
DOGS:
 < 25 lbs $33.00 per night
25 - 50 lbs $35.00 per night
> 50 lbs $38.00 
CATS:  $26 per night
Please select
DO NOT CONTINUE COMPLETING THIS FORM.  INSTEAD, please contact reception to schedule a 'Boarding Pre-screening'. Phone Numbers: 39th Ave Location (352)332-2292, Newberry Location (352)472-7035
If dropping off on Saturday, must be before 2pm. NO SUNDAY DROPOFF.
If picking up on Saturday, must be before 2pm. NO SUNDAY PICKUP.
Bath Package Pricing: 0-25lbs - $31.50 | 26-54lbs - $35.50 | 55-100lbs - $39.50 | Over 100lbs - $50.00 | Medicated Bath - $45.00
Please include name of medication, strength, and instructions.
MEDICATION MUST BE IN ORIGINAL PACKAGING.
*If you are bringing your pet's heartworm/flea prevention, please also let us know the date which you would like us to give it to them
Have they started showing signs of 'territorial aggression' or trying to bite, etc?
*We do not accept bedding, toys, or food/water bowls from home unless medically necessary
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Patient Information
67%

Boarding Release Form

To avoid potential hazards, your pets collars and leashes will be removed and returned to you when your pet is dropped off for boarding. For sanitary and parasite control reasons, we provide all bowls and bedding which we wash in hospital.  We do provide towels and blankets for our boarding canines to keep them comfortable. If your dog has a bed that needs to be with them for a medical reason, we will accommodate it but we cannot accept any responsibility for loss or damage. We do not have the capability of cleaning dog beds.  Our feline friends that board with us will be provided blankets and cushions for their comfort. 
** Dogs are walked & exercised in our yards 3 times per day Mon-Sat and 2 times per day on Sunday. Additional walks are available Mon-Fri for $10 per day (excluding holidays). Dogs with boarding reservations that include additional walks are walked 5 times per day.** 
** If your pet boards for 5 nights or longer with us you are entitled to a bath at 1/2 price (including ear cleaning and nail trim**
 
Currently, our boarding prices are the following:
 
DOGS:
 < 25 lbs $33.00 per night
25 - 50 lbs $35.00 per night
> 50 lbs $38.00 
CATS:  $26 per night
Bath Package Pricing: 0-25lbs - $31.50 | 26-54lbs - $35.50 | 55-100lbs - $39.50 | Over 100lbs - $50.00 | Medicated Bath - $45.00
Please include name of medication, strength, and instructions.
MEDICATION MUST BE IN ORIGINAL PACKAGING.
*If you are bringing your pet's heartworm/flea prevention, please also let us know the date which you would like us to give it to them
Have they started showing signs of 'territorial aggression' or trying to bite, etc?
*We do not accept bedding, toys, or food/water bowls from home unless medically necessary
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Boarding Release Form

To avoid potential hazards, your pets collars and leashes will be removed and returned to you when your pet is dropped off for boarding. For sanitary and parasite control reasons, we provide all bowls and bedding which we wash in hospital.  We do provide towels and blankets for our boarding canines to keep them comfortable. If your dog has a bed that needs to be with them for a medical reason, we will accommodate it but we cannot accept any responsibility for loss or damage. We do not have the capability of cleaning dog beds.  Our feline friends that board with us will be provided blankets and cushions for their comfort. 
** Dogs are walked & exercised in our yards 3 times per day Mon-Sat and 2 times per day on Sunday. Additional walks are available Mon-Fri for $10 per day (excluding holidays). Dogs with boarding reservations that include additional walks are walked 5 times per day.** 
** If your pet boards for 5 nights or longer with us you are entitled to a bath at 1/2 price (including ear cleaning and nail trim**
 
Currently, our boarding prices are the following:
 
DOGS:
 < 25 lbs $33.00 per night
25 - 50 lbs $35.00 per night
> 50 lbs $38.00 
CATS:  $26 per night
Bath Package Pricing: 0-25lbs - $31.50 | 26-54lbs - $35.50 | 55-100lbs - $39.50 | Over 100lbs - $50.00 | Medicated Bath - $45.00
Please include name of medication, strength, and instructions.
MEDICATION MUST BE IN ORIGINAL PACKAGING.
*If you are bringing your pet's heartworm/flea prevention, please also let us know the date which you would like us to give it to them
Have they started showing signs of 'territorial aggression' or trying to bite, etc?
*We do not accept bedding, toys, or food/water bowls from home unless medically necessary
In the event of an emergency and we are unable to reach you, who else would you like us to contact to approve medical services on your behalf?

NAME:
 Please list below the names and phone numbers for any 'authorized contacts' you would like to add to your account. 

'Authorized contacts' are defined as non-owners who you give authorization to:

1. make decisions (both medical and financial) on your behalf that you WILL BE responsible for, and

2.  drop off and pick up any of your pets from our hospitals, and

3.  authorize services on your behalf.

(Should you wish to make changes to your 'authorized contacts', this must be made in writing to the specific hospital location.) 

'Authorized Contact' Name: 
My signature below indicates that I have read and understand the following boarding requirements:

A) All animal must be current on all vaccinations:
DOGS: RABIES, DHPP/DHLPP, AND BORDETELLA
CATS: RABIES & FVRCP
B) We cannot accept any responsibility for loss or damaged personal items.
C) All animals must be free of external/internal parasites (ex: ticks, fleas, tapeworms, etc)
In the event any parasites are found, we will need to administer treatment for your pet so that these infections are not transmitted to other boarders.  This will be at the owner's expense. We will contact you regarding the treatment options. Should your pet become ill while in our care we will contact you immediately for care options.  It is essential that we are able to reach you or one of your authorized contacts.  IF we can not reach any of the above you authorize Newberry Animal Hospital to administer basic medical care to prevent disease, further illness or death.  This will be at the owners expense.

This Pet Services Agreement: (the “Agreement”) is executed and delivered by the “Owner” to “Newberry Animal Hospital Group” regarding the “Pet” (as each of those terms are defined herein). 

In consideration of the Services (as defined herein) to be provided to the Pet by a hospital under Newberry Animal Hospital Group, Owner agrees as follows: 
Services of our hospital:
1. Newberry Animal Hospital Group has agreed to provide to the Pet certain boarding, daycare, grooming, training, veterinary or other services or goods (the “Services”) requested by Owner from time to time, at one or more facilities of Newberry Animal Hospital Group (each, a “Facility”), subject to Owner’s payment of all Charges (as defined herein) and to the terms of this Agreement.
2.  Notwithstanding any other provision of this Agreement, Newberry Animal Hospital Group may refuse to provide, or refuse to continue to provide, any Services to the Pet, at any time and for any reason, in its sole and absolute discretion.  

Payment for Services:
1.  Owner will pay in full all charges for all Services provided by Newberry Animal Hospital Group, or provided by others at the request of Newberry Animal Hospital Group (collectively, the “Charges”), not later than the end of each visit.  Newberry Animal Hospital Group will also have the right to require that Owner provide a deposit or pay in advance for any Services. 
2.   If Owner fails to pick up the Pet on its scheduled checkout date, Newberry Animal Hospital Group may, at its option, continue to provide to the Pet any or all of the Services and Owner will be obligated for the payment of those Services at the then-current rates of Newberry Animal Hospital Group.  
3.  Owner authorizes Newberry Animal Hospital Group to charge any credit card of Owner on file with Newberry Animal Hospital Group for any Charges not paid by Owner when due. 

Owner’s Warranties and Representations:
Owner warrants and represents to Newberry Animal Hospital Group that:
1.  Owner is the sole owner of the Pet, free and clear of any claim, lien or encumbrance, and has full power and authority to enter into this Agreement.
2.  All information provided by Owner regarding the Pet is accurate and complete, and Owner has fully disclosed to Newberry Animal Hospital Group any pre-existing illnesses, injuries or and behavioral problems or conditions regarding the Pet. 
3.  The Pet has not been exposed to rabies, distemper, parvovirus, upper respiratory infection or any other contagious disease within the thirty (30) days immediately prior to each stay at a Facility.
4.  Each of Owner’s warranties and representations will be true and correct during all current and future visits by the Pet to any Facility.
Pet Health Services.
1. If Newberry Animal Hospital Group, in its sole and absolute discretion, determines that the Pet requires any medical treatment (including surgery or anesthesia), hospitalization, care or attention (“Medical Services”) while in its care, Newberry Animal Hospital Group will be authorized to provide, or engage any veterinarian to provide, and to transport the Pet if necessary to obtain, such Medical Services.  Owner will pay all Charges for such Medical Services and transportation immediately upon the request of Newberry Animal Hospital Group, but in any event not later than the end of the Pet’s visit.  
Owner also authorizes Newberry Animal Hospital Group to immediately charge any credit card of Owner on file with it for any Charges for such Medical Services and transportation.
2.  If Newberry Animal Hospital Group determines that the Pet was brought to a Facility infested with fleas, ticks, or other parasites, Newberry Animal Hospital Group may provide to the Pet any medication, bath or other necessary treatment and Owner will pay all Charges regarding such medication, baths or treatment.Emergency Situations.In the event of a storm, flood, other natural disaster or other emergency situation that affects the ability of Newberry Animal Hospital Group to fully and safely operate a Facility, Newberry Animal Hospital Group will attempt to contact Owner to pick up its Pet from the Facility.  
If (a) Newberry Animal Hospital Group contacts Owner and Owner fails to immediately pick up the Pet, 
(b) Newberry Animal Hospital Group attempts to but is unable to contact Owner, or 
(c) Newberry Animal Hospital Group determines, in its sole and absolute discretion, that due to the emergency nature of the situation, there is not sufficient time to contact Owner or provide Owner an opportunity to pick up the Pet, Newberry Animal Hospital Group will have the right, but not the obligation, to relocate the Pet to another Facility or other location.  In such event, Owner will be obligated to pay Newberry Animal Hospital Group for all Charges associated with the transportation of the Pet and the Services provided to the Pet at the other Facility or location.

Abandoned Pets:
1.  If Owner has not picked up the Pet within five (5) days of its scheduled checkout date, Newberry Animal Hospital Group may send to Owner a written notice, by regular United States Mail to the most current address of Owner on file with Newberry Animal Hospital Group, requiring that Owner pick up the Pet from the Facility within ten (10) days of the date of such notice and pay all outstanding Charges owed to Newberry Animal Hospital Group.  
2. If Owner fails to pick up the Pet and Pay all outstanding charges as required in the Notice, the Pet will be deemed to be an “Abandoned Pet,” and Owner will have no further ownership right or claim regarding the Pet. 
3.  Newberry Animal Hospital Group may, at its option, place any Abandoned Pet with any humane society, animal shelter or animal rescue group, or permit any person selected by Newberry Animal Hospital Group, in its sole discretion, to adopt the Abandoned Pet.
4.  Owner hereby waives any statutory right to notice or other rights of Owner regarding any Abandoned Pet provided under applicable law. Notwithstanding the foregoing, Newberry Animal Hospital Group may, at its option, exercise any rights and remedies regarding any Abandoned Pet provided under applicable law in addition to or in lieu of its rights and remedies under this Agreement.  
5.  No actions of Newberry Animal Hospital Group regarding any Abandoned Pet will relieve Owner of any liability for any outstanding Charges owed to Newberry Animal Hospital Group regarding the Abandoned Pet. 

ACKNOWLEDGMENT AND ASSUMPTION OF RISKS:
Owner acknowledges and understands that: 
(a) there are inherent and potential risks associated with interactions between pets and other pets (including during group play),  interactions between pets and humans, and  pets being housed in a group environment; and 
(b) there are other risks arising out of or related to the Pet’s presence at a Facility or use of Services that may not be known to or foreseeable by Owner or Newberry Animal Hospital Group (collectively, “Risks”).  
Risks include:  
• Exposure of the Pet to contagious diseases, viruses or infections, including bordetella (“kennel cough”), canine influenza, respiratory viruses or infections, gastrointestinal conditions or skin conditions;
• Exposure of the Pet to fleas, ticks, mites, roundworms, hookworms, tapeworms, heartworms or other external or internal parasites;
• Exposure of Pet to substances that may cause allergic reactions;
• “Bloat,” GDV or similar gastric events;           
• Bites, abrasions, lacerations, sprains, fractures or other injuries;• Premises and equipment defects and conditions;
•  Risks associated with transporting the Pet;• Property damage or loss, illness, physical or emotional injury, and death of or to the Pet, Owner or any other pet or person; and
• Claims, demands, liability, damages, costs, expenses, attorney’s fees and court costs arising or related to any of the foregoing.

I HEREBY KNOWINGLY AND VOLUNTARILY ASSUME ALL RISKS (INCLUDING THE RISKS DESCRIBED ABOVE) WHETHER SUCH RISKS ARE KNOWN OR UNKNOWN, FORSEEABLE OR NOT FORSEEABLE, OR CAUSED BY THE NEGLIGENCE OF Newberry Animal Hospital Group OR ANY OTHER PERSON OR ENTITY.

WAIVER AND RELEASE OF CLAIMS; AGREEMENT NOT TO SUE.
I WAIVE AND RELEASE Newberry Animal Hospital Group, ITS MEMBERS, SHAREHOLDERS, MANAGERS, DIRECTORS, OFFICERS, EMPLOYEES, INVITEES, AGENTS, REPRESENTATIVES, CONTRACTORS, LANDLORDS, TENANTS AND INSURERS, AND THE HEIRS, SUCCESSORS AND ASSIGNS OF EACH OF THEM (EACH, A “RELEASED PARTY” AND, COLLECTIVELY, THE “RELEASED PARTIES”) FROM ANY AND ALL CLAIMS, DEMANDS, CAUSES OF ACTIONS, ACTIONS, LAWSUITS, DAMAGES, JUDGMENTS, ATTORNEY’S FEES, COSTS, LIABILITIES, LOSSES OR EXPENSES (COLLECTIVELY, “CLAIMS”), WHETHER KNOWN OR UNKNOWN, WHETHER ACCRUED OR UNACCRUED, OR WHETHER CAUSED BY THE NEGLIGENCE OF ANY RELEASED PARTY, INCLUDING CLAIMS FOR PROPERTY DAMAGE OR LOSS, ILLNESS, INJURY OR DEATH OF OR TO MY PET OR ME, ARISING OUT OF OR RELATED TO: 
(a) THE SERVICES, 
(b) MY PET’S PRESENCE AT ANY FACILITY OR OTHER LOCATION IN CONNECTION WITH THE SERVICES, (c) THE DISPOSITION OF ANY ABANDONED PET, OR (d) ANY OTHER ACT OR OMISSION OF ANY RELEASED PARTY. 
I ALSO AGREE NOT TO SUE ANY RELEASED PARTY REGARDING ANY SUCH CLAIMS, AND WAIVE MY INSURERS' RIGHTS TO BRING ANY CLAIMS AGAINST Newberry Animal Hospital Group OR ANY OTHER RELEASED PARTY BASED ON ANY PAYMENTS MADE TO OR ON BEHALF OF ME REGARDING SUCH CLAIMS.BEHAVIOR AND ACTIONS OF PET; 

INDEMNIFICATION:
1.   Owner will be solely responsible for all behavior and actions of the Pet while at any Facility or other location in connection with the Services or pursuant to this Agreement.
2.    I HEREBY AGREE TO INDEMNIFY, HOLD HARMLESS AND, IF REQUESTED BY Newberry Animal Hospital Group, DEFEND Newberry Animal Hospital Group AND ANY OTHER RELEASED PARTIES FROM AND AGAINST ALL CLAIMS, WHETHER KNOWN OR UNKNOWN, WHETHER ACCRUED OR UNACCRUED AND WHETHER CAUSED BY THE NEGLIGENCE OF ANY RELEASED PARTY, INCLUDING CLAIMS FOR PROPERTY DAMAGE OR LOSS, ILLNESS, INJURY OR DEATH OF OR TO MY PET, ANY OTHER PET, ME OR ANY OTHER PERSON OR ENTITY, ARISING OUT OF OR RELATED TO 
(a) THE BEHAVIOR AND ACTIONS OF THE PET WHILE AT ANY FACILITY OR OTHER LOCATION IN CONNECTION WITH THE SERVICES OR PURSUANT TO THIS AGREEMENT;
(b) ANY INJURIES TO THE PET, ANY OTHER PETS OR ANY PERSON, OR DAMAGE TO ANY FACILITY OR OTHER PROPERTY, CAUSED IN WHOLE OR IN PART BY THE PET; 
(c) ANY BREACH BY OWNER OF ANY TERM OR CONDITION OF THIS AGREEMENT; OR 
(d) THE FALSITY OF ANY WARRANTY OR REPRESENTATION MADE BY OWNER TO Newberry Animal Hospital Group.
3.    If the Pet bites another pet or person, Owner authorizes Newberry Animal Hospital Group to report such bite, and provide Owner’s name and contact information, to (a) any appropriate authorities, 
(b) any veterinarian or medical provider treating the bitten pet or person, or 
(c) the owner of the bitten pet or the person who was bitten. 

ARBITRATION; WAIVER OF JURY TRIAL
1.    Any claim or dispute between Owner and Newberry Animal Hospital Group regarding this Agreement or its subject matter which has not been resolved through negotiation between the parties will be settled and determined through arbitration in accordance with the Rules of Commercial Arbitration of the American Arbitration Association.  Such arbitration will be conducted by a single arbitrator to be agreed upon by the parties, or if the parties cannot agree upon a single arbitrator, each party shall select an arbitrator who shall then select a single arbitrator who shall conduct the arbitration. Any arbitration conducted pursuant to this Agreement will be conducted in Jacksonville, Florida, unless prohibited by applicable law. The written decision of the arbitrator shall be binding, final and conclusive on the parties and shall be the exclusive final remedy of the parties under this Agreement.  The arbitrator shall determine the costs and fees of the prevailing party, including reasonable attorney’s fees, and such costs and fees shall be included in the arbitration award. Judgment on the award rendered by the arbitrator may be entered in any court having jurisdiction thereof. 
4.    IF FOR ANY REASON THE FOREGOING ARBITRATION PROVISIONS ARE FOUND TO BE UNENFORCEABLE, OWNER KNOWINGLY AND VOLUNTARILY WAIVES ANY RIGHTS IT MAY HAVE TO A JURY TRIAL REGARDING ANY DISPUTE ARISING OUT OF OR RELATED TO THIS AGREEMENT OR THE MATTERS DESCRIBED HEREIN, AND CONSENTS TO THE EXCLUSIVE JURISDICTION OF ANY FLORIDA STATE COURT OR FEDERAL COURT SITTING IN JACKSONVILLE, FLORIDA REGARDING ANY LITIGATION, LEGAL PROCEEDING OR DISPUTE ARISING UNDER OR IN CONNECTION WITH THIS AGREEMENT. 
Photographic and Video Release. Owner irrevocably grants to Newberry Animal Hospital Group, its agents, and licensees, and any press or news agencies authorized by Newberry Animal Hospital Group, the right and license, without payment of any royalty or other compensation, to photograph, videotape or record, by any means and in any medium, the Pet’s image, likeness, sound and voice, and to publish, copyright, use or alter any images, likenesses or recordings of the Pet (with or without the name of the Pet or any fictitious name), for any commercial, educational, charitable or other lawful purposes, without any consent or approval of Owner. 

Miscellaneous.
1.  This Agreement contains the entire agreement between Newberry Animal Hospital Group and Owner and supersedes any prior agreement between the parties regarding the subject matter of this Agreement. Notwithstanding the foregoing, the rights and remedies in favor of Newberry Animal Hospital Group and the representations, warranties and covenants of Owner provided under this Agreement, are in addition to, and not in limitation of, the rights and remedies in favor of Newberry Animal Hospital Group and the representations, warranties and covenants of Owner provided under any consents to or authorizations for veterinary services executed and delivered by Owner to Newberry Animal Hospital Group.
2.  All terms and conditions of this Agreement will bind and benefit Newberry Animal Hospital Group, Owner, any other owner of the Pet, and the heirs, administrators, personal representatives, successors and assigns of each of them. 
3.  This Agreement will be applicable to all Services provided by Newberry Animal Hospital Group to the Pet at any Facility or other location on or after the date of this Agreement. 
4.  Owner will pay all collection costs, including attorneys’ fees and court costs, regarding any Charges owed to Newberry Animal Hospital Group that are not paid when due.
5.  If any provision of this Agreement is held to be invalid or unenforceable, the balance of this Agreement will continue in full force and effect, to the fullest extent permitted by law or equity.
6.  This Agreement will be governed by the laws of the State of Florida, without any reference to principles of conflicts of laws. >>
7. Execution and/or delivery of this Agreement by electronic signature, facsimile, electronic mail or other electronic device or means shall constitute good and valid execution and delivery of this Agreement.  An executed facsimile, photocopy or electronic copy of this Agreement will have the same force and effect as the original for all purposes and will be admissible in evidence as the original itself in any judicial or administrative proceeding.

Definitions and Interpretation.For purposes of this Agreement:
•   “Owner,” “I,” “me,” and “my,” mean and refer to, the Owner(s) named below, both individually and collectively.
•  “Newberry Animal Hospital Group” means any Newberry Animal Hospital, Newberry Animal Holistic & Wellness, its past, present and future parents, subsidiaries and affiliates, both individually and collectively.
•   “Pet” means, individually and collectively,  each pet now or hereafter owned by Owner that receives any Services from and after the date Owner has executed this Agreement.
•   “Including” or variations of that word shall be deemed to be followed by the words “without limitation.”
•   "Or" has, except where otherwise indicated, the inclusive meaning represented by the phrase "and/or."
•   Any headings used in this Agreement are for convenience only and shall not affect the construction or interpretation of this Agreement.

I HAVE READ THIS AGREEMENT AND UNDERSTAND THAT IT INCLUDES ASSUMPTION OF RISKS, WAIVER AND RELEASE OF CLAIMS, AGREEMENT NOT TO SUE AND INDEMNIFICATION PROVISIONS.  I AM KNOWINGLY  AND VOLUNTARILY ENTERING INTO THIS AGREEMENT.
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