Emergency Instructions if you or your contact cannot be reached
Veterinary Information
Veterinary Name
Office Name
Address Line 1
Address Line 2
City
Zip
Phone
How Did You Hear About Us?
First Dog Information
Name
Breed
Age/Birth Date
Gender
Male Female
Rabies Vaccination Expiration Date
Food Amount and Routine
Check All that Apply
Is your animal spayed or neutered?
Ever aggressive with people?
Friendly with other dogs?
Possessive of toys around other dogs?
Possessive around his/her food?
Ever been to a Dog Park or Doggy Daycare?
Medical/Behaviour or any other Concerns
Second Dog Information
Name
Breed
Age/Birth Date
Gender
Male Female
Rabies Vaccination Expiration Date
Food Amount and Routine
Check All that Apply
Is your animal spayed or neutered?
Ever aggressive with people?
Friendly with other dogs?
Possessive of toys around other dogs?
Possessive around his/her food?
Ever been to a Dog Park or Doggy Daycare?
Medical/Behaviour or any other Concerns
If your camper(s) has a favorite blanket, bed, toy, etc, they are welcome to
bring it along to Camp. Sometimes these items get shared and damaged by
other "Campers", so please understand that when bringing these
items, they may not be returned to you in the same condition as you
brought them. Camp Ilene is not responsible or liable for any
damages done to your pets personal property. Also, please make
sure that anything you do send with your dog is clearly labeled,
so we can make sure you get it back!
My signature
(initials) on this document indicates that I have read it and clearly
understand all of its terms.
I,
the Client, authorize Camp Ilene to perform pet care services for my
pet. My pet is current on all vaccinations and licenses. I certify that
my pet has not been ill with any communicable condition in the last 30
days. I
understand that Camp Ilene will not accept dogs unless they have been
spayed or neutered.
I
understand and agree that my dog(s) will at all times while attending
Camp Ilene, have current vaccination status.I further understand that even if my dog is vaccinated for
Bordatella (Kennel Cough) there is a chance that my dog can still
contract Kennel Cough.I
agree that I will NOT hold Camp Ilene responsible if my dog(s) contracts
Kennel Cough.I
understand that having my dog in the company and environment of other
dogs may involve risks regarding the contraction of illness. I
understand that even regular vaccinations cannot completely guard
against illness and disease, and that Camp Ilene cannot in any way
prevent, nor are they responsible for, any illness that my dog might
contract.
I
understand that there are risks inherent in having my dog boarded in an
environment where the dogs are not kept in cages and are around other
dogs and people.I
understand that it is not always possible for Camp Ilene to prevent
injuries that may occur during off-leash activities.All
dog play is carefully monitored by Camp Ilene to avoid injury, but
scratches, punctures, torn ligaments, etc., may occur despite the best
supervision.I
understand and agree, that Camp Ilene, its employees, staff or
volunteers, will not be liable for any illness, injury, death, and/or
escape of my dog.I
acknowledge that Camp Ilene, its employees, staff or volunteers will
take such actions as are reasonable to minimize these risks.I will be responsible for the actions of my dog if it
causes any damage whatsoever, including but not limited to damage or
injury to other dogs, people, or objects while in the care of Camp
Ilene.I further understand and agree that my dog will have access
to a fenced outside area and I agree to assume full liability if my dog
escapes.
I
understand and agree that Camp Ilene is not responsible for any injury
to, or damage from, any cause whatsoever caused to, or by my dog, while
it is in the care of Camp Ilene, provided that Camp Ilene has taken
reasonable precautions to prevent such injury or damage, and I agree to
indemnify Camp Ilene, its directors, shareholders, employees and
servants from any loss, injury or damage they may suffer as a result of
my dog, or any damage to me as a result thereof.
I
warrant that my dog(s) is/are suitable to be in the care of Camp Ilene
and is/are in good health and have not harmed, shown aggression or
exhibited any threatening behavior towards any person or other dog.My dog is obedient and capable of following instructions.I
further understand and agree that Camp Ilene reserves the right to use a
bark control device, if my dog(s) creates a disturbance to the
neighborhood.I will immediately advise Camp Ilene of any problems with my dog that
could affect its behavior, health or suitability for a communal living
environment and off-leash activities.
I
understand that there are risks involved in having my dog cared for by
Camp Ilene. In the event of illness or injury, I authorize Camp Ilene to
take my dog to the nearest vet considered to be the most suitable by
Camp Ilene, its directors, shareholders, employees or servants, should
Camp Ilene deem it advisable. I agree to pay all vet care required or
advised, in the opinion of the vet, to the amount specified on my
Veterinarian Authorization Form.If
the required care will exceed that amount, I know that Camp Ilene will
try to contact me at the telephone numbers I have given when placing
reservations for my dog(s). If they cannot reach me, Camp Ilene is
authorized to use their best judgment in deciding whether to go ahead
with any form of treatment recommended by the vet, whether the cost of
such treatment exceeds my maximum amount specified on the Veterinarian
Authorization Form or otherwise, and I agree to pay for all such care.
I
hereby release Camp Ilene from all liabilities related to
transportation, treatment, prescribed medications and expense. I agree
to reimburse Camp Ilene for any additional fees for tending to emergency
care as well as any expenses incurred for any other unexpected
veterinary, food or other supply needs. I assume full financial
responsibility for any and all expenses involved.
I
represent and warrant to Camp Ilene that I have fully disclosed to it
any history which my pet(s) may have of aggression, biting or causing
other injury or damage to person, other animals or property, and I
understand that Camp Ilene reserves the right to refuse service as a
result thereof. Client will be liable for medical care expenses and
damages that result from an animal bite. I further understand and agree
that Camp Ilene and their staff will not be liable for any problem(s)
that develop, and I hereby release them of any liability of any kind
arising from my dog’s attendance and participation at Camp Ilene.
I
further understand and agree that if my dog(s) is/are not picked up by
the end of the Camp Ilene regular business day, then I hereby expressly
authorize Camp Ilene to take whatever action is deemed necessary for the
continuing care of my dog(s) and I agree and promise to pay to Camp
Ilene all costs of continuing such care upon demand by Camp Ilene.Further, I understand that if I do not pick up my dog(s) as
scheduled, Camp Ilene shall be authorized to proceed according to
California Civil Code section 1834.5 (“Abandoned animals; disposition;
notice), which section provides as follows:
“Notwithstanding
any other provision of law, whenever any animal is delivered to any
veterinarian, dog kennel, cat kennel, pet grooming parlor, animal
hospital, or any other animal care facility pursuant to any written or
oral agreement entered into after the effective date of this section,
and the owner of such animal does not pick up the animal within 14
calendar days after the day time animal was to be picked up, the animal
shall be deemed abandoned.The
person into whose custody the animal was placed for care shall try first
for a period of not less than 10 days to find a new owner for the
animal, and, if unable to place the animal with a new owner, shall
thereafter humanely destroy the animal so abandoned.There shall be a notice posted in a conspicuous place, or in
conspicuous type in a written receipt give, to warn each person
depositing an animal at such animal care facilities of the provisions of
this section.”
I
further understand and expressly agree that each and every of the
foregoing provisions containing in all paragraphs above shall be in
force and effect and shall apply to each and every occasion on which I
board or deposit my dog(s) with Camp Ilene for daycare, or extended
boarding, as the case may be; and that this Agreement shall remain in
full force and effect as between the parties until and unless otherwise
cancelled or superceded by a writing signed by the parties
This
service contract shall be governed by and construed in accordance with
the internal laws of the State of California applicable to contracts to
be performed wholly within the State, without giving effect to the law
of conflicts of laws applied thereby.
My
initials on this document indicates that I hereby
certify that I have read and understand these rules and regulations set
forth above in this Agreement, and each of its terms and conditions, and
agrees to abide and be bound by these rules and regulations.
Understood and agreed to by:
Initials of Owner
Please click here to print the Waiver
& Vet Authorization Form, complete and bring with you when you
come to Camp along with a copy of your dogs rabies certificate.
NOTICE:
YOU WILL BE RECEIVING A PERSONAL EMAIL FROM ILENE TO CONFIRM YOUR RESERVATION.
IF YOU DO NOT RECEIVE AN EMAIL FROM US WITHIN 24 HOURS OF SENDING YOUR RESERVATION,
PLEASE CALL US TO CONFIRM THAT WE RECEIVED YOUR RESERVATION
Additionally. Please ensure that your email client will accept all email from CampIlene.com.
If you are employing some method of spam filtering requiring confirmation before
email will be accepted we will not be responding to those requests.
Contact
info: 951-371-8458
Riverside, San
Bernardino & Orange County, California Ilene@campilene.com