NEW APPLICANT FORM PLEASE SUBMIT THIS FORM IN PREPARATION FOR YOUR FIRST APPOINTMENT CONTACT INFORMATION NAME OF PARENT(S) GUARDIAN(S) * First Last First Last ADDRESS* Street Address City ZIP / Postal Code RESIDENTIAL PHONE*CELLULAR*BUSINESS PHONEE-MAIL ADDRESS* TYPE OF MEMBERSHIP (Please select all that apply.)* SINGLE PET SERVICE MULTIPLE PET SERVICE DOGGIE DAYCARE HOTEL OTHER DETAILS ABOUT YOUR PET(S)PET 1 NAME / BREED / AGE*YOUR PETS NAME: BREED: DOB/AGE: OTHER INFO** DOG CAT * FEMALE MALE SPAYED / NEUTERED ** YES NO PET 2 - NAME / BREED / AGEYOUR PETS NAME: BREED: DOB/AGE: OTHER INFO* DOG CAT SPAYED / NEUTERED * FEMALE MALE YES NO EMERGENCY CONTACTList names of emergency contact(s), and those who are authorized to pick up your pet(s):NAME*RELATIONSHIP*CONTACT NO.*FEEDING DETAILSLet us know how you would like your pet(s) fed. Indicate the meal time, quantity, and details for type of feed (Kibble, Wet, Mix etc.).PET 1 BREAKFAST PORTIONS (in cups)**None1/4 cups1/2 cups3/4 cups1 cups1.5 cups2 cups2.5 cups3 cupsPET 1 LUNCH PORTIONS**None1/4 cups1/2 cups3/4 cups1 cups1.5 cups2 cups2.5 cups3 cupsPET 1 DINNER PORTIONS**None1/4 cups1/2 cups3/4 cups1 cups1.5 cups2 cups2.5 cups3 cupsPET 2 BREAKFAST PORTIONS**1/4 cups1/2 cups3/4 cups1 cups1.5 cups2 cups2.5 cups3 cupsN/APET 2 LUNCH PORTIONS**1/4 cups1/2 cups3/4 cups1 cups1.5 cups2 cups2.5 cups3 cupsN/APET 2 DINNER PORTIONS**1/4 cups1/2 cups3/4 cups1 cups1.5 cups2 cups2.5 cups3 cupsN/AADDTIONAL INFORMATIONPlease list concerns such as food allergies, medications, shyness around dogs/people, separation anxiety, toy/food guarding, pre-existing health concerns (limp, sores, etc).NAME OF VETERINARY CLINIC(S)(please list all, and any relevant information)NOTE: Up-to-date vaccination records as outlined in our Terms of Service Agreement must be submitted no later than your first appointment.AGREEMENT TO MEDICAL RELEASE* By submitting this form I give Just Pet Me Country Club permission to release information on this application and select a veterinary clinic or service provider at their discretion in the event that my pet(s) need emergency medical, surgical treatment or hospitalization. SIGNATURE AGREEMENT TO TERMS & CONDITIONS OF SERVICE BY JUST PET ME COUNTRY CLUB, LLCTERMS & CONDITIONS OF SERVICE Just Pet Me Country Club screens all owners/guardians and pets before enrollment in our daycare or hotel program. By signing this contract you warrant that all information is true and accurate, and there are no issues which would cause Just Pet Me to exclude your pet from enrollment at Just Pet Me. Just Pet Me Country Club reserves the right to refuse service to any owner or guardian for any reason. Below is an overview of Just Pet Me rules and regulations that all owners/guardians agree to abide by. ASSESSMENT Every owner/guardian seeking membership for their dog must make an appointment for Just Pet Me staff to conduct a two part evaluation, measuring your dog’s comfort level within our environment to interact with our staff and other members. Canine assessment & membership fee is up to $25 per dog. Potential members must possess a temperament that permits Just Pet Me staff to care for them and may not pose as a danger to Just Pet Me staff and members. If your pet is unable to meet these safety requirements, management reserves the right to enroll your pet in an alternative program in which your pet will not be in contact with other Just Pet Me members or all Just Pet Me staff. This Just Pet Me Get Away Program costs up to $150 per day and applies under the following circumstances: Unfixed Medical needs Displays behavior that is not conducive to interacting with all other dogs Every owner/guardian must also complete the Just Pet Me Applicant Information form during the assessment. A completed & signed Applicant Information form, signed Terms & Conditions of Service Agreement, payment, and mandatory vaccination records must be submitted prior to the first reservation. Feline membership fee is $10 per cat. HEALTH & VACCINATIONS Just Pet Me Country Club reserves the right to not accept the following: Guests that have a terminal illness Guests that have had communicable illness of any kind within 30 days prior to check in Guests that have been exposed to a communicable illness within 30 days prior to check in Guests that are over the age of twelve (12) years of age If you fail to inform Just Pet Me of your pet’s exposure to any communicable illness, you will be responsible for any medical charges resulting from your negligence. In addition, owners/guardians that violate these terms will be responsible for any damages resulting from the illness spreading to other Just Pet Me members. Just Pet Me requires guests to be on a regular flea treatment program, such as a topical treatment once per month, or a treatment applied within seven days of check in. If our staff discover fleas on your pet, Just Pet Me reserves the right to take immediate action to treat your pet and attempt to remove the fleas or ticks at cost to you of $75. If Just Pet Me is unable to remove the fleas, you will also be responsible for any charges resulting from Just Pet Me obtaining a flea deterrent prescription from a veterinarian. Just Pet Me is not responsible for any fleas on your pet. If Just Pet Me staff find ticks on your pet, we will charge ten dollars to remove each tick. If Just Pet Me staff find worms in your pet’s feces, we will notify you. If we are able to collect an adequate stool sample, we will charge ten dollars. If you request Just Pet Me staff to deliver this stool sample to a veterinarian or purchase de-worming medication, Just Pet Me will charge you fifty dollars. You will also be charged for cost of the medication and/or veterinarian evaluation. Canine vaccinations: all dogs must be currently vaccinated for Bordetella, Distemper, and Rabies. Bordetella must be administered at least 48 hours before check in. Puppies under the age of six months must provide proof of de-worming treatment. Proof of vaccinations is required prior to guests checking in to Just Pet Me. Daycare members must stay current throughout the duration of their membership. Although Just Pet Me notifies our distinguished daycare members as a courtesy, Just Pet Me is not responsible for keeping you apprised of your pet’s vaccination schedule. Membership is revoked and refunds will not be issued to owners/guardians who refuse to keep their pet up-to-date in accordance with vaccination requirements. Feline vaccinations: all cats must be vaccinated for Rabies, Feline distemper, and Feline leukemia. If your vet does not recommend Feline leukemia, you must obtain a signed statement confirming the recommendation and absence of disease and submit this statement to Just Pet Me prior to check in. All dogs and cats over six (6) months of age must be spayed or neutered. All guests who are not in compliance with this requirement are subject to enrollment in the Just Pet Me Getaway Program outlined above. The daily cost is $150. If vaccination records are not received by the time your pet checks in, Just Pet Me reserves the right to obtain completed vaccinations, at a cost of $25, by contacting your veterinarians. If Just Pet Me transports your pet to obtain vaccinations, the cost is $100 plus veterinarian’s fees. RESERVATIONS To guarantee a reservation, Just Pet Me requires a credit card at the time of booking. Payment is due at the time of check in. If you do not notify Just Pet Me at least 24 hours in advance of your trip cancellation, there is a $100 fee. LOBBY HOURS Monday through Friday: 6AM – 9PM Saturday: CLOSED. Distinguished daycare guests and assessments by appointment Sunday: 8AM-10AM | 3PM – 4PM | 7PM – 8PM Please submit a written request to Just Pet Me if you wish for a guardian not listed on your application to pick up your pet. Identification such as a Driver’s License will be required when your pet is picked up. HOLIDAY SCHEDULE CLOSED: New Year’s Day, Thanksgiving Day, & Christmas Day 8AM-10AM | 3PM – 4PM | 7PM – 8PM: Martin Luther King Jr.’s Birthday, Washington’s Birthday, Memorial Day, Labor day, Independence Day, Veteran’s Day, Columbus Day Limited lobby hours on Christmas Eve and New Year’s Eve. Please inquire for annual schedule. AFTER HOUR PICK-UP FEE If you make prior arrangements with Just Pet Me management to pick up or drop off your pet when our lobby is closed, you agree to pay a fee of $20 each time. No pets will be released after hours without prior management approval. PAYMENT FOR SERVICES Owner/guardians agree to pay Just Pet Me all applicable charges by cash, check or credit card prior to drop off. Owner/guardians agree to pay the pet care service rate in effect on the date that pet is checked into Just Pet Me and to pay for any additional services when owner/guardian picks up pet. Owner/guardian agrees that pet shall not leave the facility until all charges due are paid by owner/guardian. Just Pet Me may change fees at any time by posting notices in our facility and on our website. Returned checks are subject to a $25 administrative fee plus all fees charged by our bank. Credit card refunds are subject to reduction for fees charged by our credit card company. PET NAME(S): Daycare $_______________________ Hotel $________________________ Bath $ ____________________ Other $___________________________ NOTE: VISIT POLICIES AND REQUIREMENTS Personal items: prior to checking in, please label all of your pet’s belongings. We may not be able to return your item if it is not labeled. Just Pet Me is not responsible for any damages to your pet’s personal items. Cat carriers: all feline guests must arrive in a cat carrier, which will remain at Just Pet Me until check out. Leash and other gear: all canine guests must arrive with a leash that is attached to either a collar or a harness. Please make sure that your dog’s name is displayed on either the collar or the harness. Medication: Just Pet Me staff do not administer injections. If your pet has medical requirements approved by Just Pet Me management, you must bring your own supplies. This includes, but is not limited to, food for pill administration and measurement devices. The fee for administering medication depends on complexity of the procedure. The typical price is $5 per administration. Special diets are typically $10 per meal. Nails: if your pet’s nails may injure staff or other guests, Just Pet Me will charge you $20 for trimming the nails. Time-out and Muzzles: if your dog is bullying another guest, first we give a five minute time-out in which your dog will be separated from the group. If your pet continues to exhibit undesired behavior, the next time-out is one hour. Just Pet Me reserves the right to use a muzzle if time-out procedures do not prevent your dog from bullying another guest. Crates: each guest has their own crate during meal times and rest periods. For families with multiple dogs, crates may be shared during rest times only. Dogs must be separated during meal times due to safety concerns. Water: Just Pet Me uses water for cleaning the outdoor areas, playing games, and filling drinking stations. It is very common for dogs to get wet during the course of their visit. Running out of food: please provide enough food for your dog’s visit at Just Pet Me. If your pet runs out of meals, we will provide kibble at a cost of $5 per day. It is very common for pets to have diarrhea as a result of a sudden change in diet, so please maintain a consistent diet for your pet while away from home. Stress: pets that are not accustomed to being away from home may exhibit behavior such as not eating or drinking. Just Pet Me will repeatedly offer your pet food and water, but cannot guarantee your pet will eat and drink to your satisfaction. If this occurs, your pet may eat or drink more than usual when he/she returns home. Other symptoms of stress may include anti-social behavior or aggression. If this occurs, Just Pet Me staff will contact you to discuss possible program adjustments. Emergencies: in an emergency, Just Pet Me staff will attempt to contact you or the emergency contact you provided on the application. You authorize Just Pet Me to obtain medical attention for your pet from any qualified veterinarian when Just Pet Me deems such medical care is important to your pet’s health. If your pet is transported to or from Just Pet Me by Just Pet Me staff, you hold Just Pet Me harmless in the event of injury or accident during transport. You grant Just Pet Me and its staff or agents full authority to make decisions involving the medical treatment of your pet and agree to pay for all related costs. This applies to any claims for injuries or damages related to such medical care or that arise due to the transport of your pet to a veterinary clinic. In the event of your pet’s death, you or your emergency contact will be notified immediately. You agree that Just Pet Me’s liability shall under no circumstances exceed $200 per pet admitted. WAIVER AND RELEASE By signing this waiver and release, you as owner/guardian assume full responsibility of your pet’s behavior and any resulting damages and injuries to property, pets, and persons caused by your pet even if there is alleged negligence by Just Pet Me. ASSUMPTION OF RISK Owner/guardian acknowledge that employees of Just Pet Me Country Club are not trained in veterinary medicine and are not expected to diagnose or detect illness in guests that visit Just Pet Me. Owner/guardians acknowledge that vaccines do not protect against all communicable illness and strains that may affect their pet. Owner/guardian acknowledge and agree that they are assuming all risk or disease, harm, illnesses by allowing their pet to visit Just Pet Me. Owner/guardian acknowledge and agree assumption of all risk of damages cause by their pet to any Just Pet Me employee, asset, or guest. INDEMNIFICATION OF JUST PET ME : Owner/guardian agree to indemnity, defend and hold Just Pet Me harmless from any and all claims, actions, causes of actions, losses, damages, liabilities, costs, judgments, and attorney fees to which Just Pet Me may become subject to, relating to or arising out of their pet’s presence at Just Pet Me or caused by their pet. WAIVER AND RELEASE Owner/guardian hereby waive all claims and releases Just Pet Me from all liability to my person, my pet, agents, representatives, successors and assigns for all liability, claims, damage, or demands for personal injury, death, or property damage, know or unknown, passed or future, arising from or related to Just Pet Me services provided whether the illness, injury, death, or property damage occurs on or off Just Pet Me premises. This release includes, without limitation, any personal injury, death, or property damage causes the active or passive negligence of any of Just Pet Me and I bear sole responsibility for any loss. I acknowledge that I have carefully read the Just Pet Me terms & conditions of service, as well as this waiver and release, and understand all content and that this agreement includes an assumption of risk of Just Pet Me’s negligence and liability. I acknowledge that Just Pet Me is materially relying on this waiver and is allowing my pet to actively participate in their program. Any controversial claims arising out of this agreement, or the breech thereof, or as a result of any claim or controversy involving the alleged negligence of any party of this agreement, shall be settled in accordance to the rules of the American Arbitration Association, and judgment upon the reward rendered by the arbitrator may be entered in any court having jurisdiction thereof. The arbitrator shall, as part of the award, determine and award to the prevailing party the costs of such arbitration and reasonable attorney’s fees or the prevailing party. The arbitrator(s) shall apply California law to the merits of any dispute or claim, without reference to conflicts of law rules. The parties hereby consent to the personal jurisdiction of the state and federal court located in California and agree that such courts shall have the sole and exclusive jurisdiction for any action or proceeding arising from or relating to this Agreement or relating to any arbitration in which the parties are participants. ALL PARTIES TO UNDERSTAND THAT BY SIGNING THIS AGREEMENT THEY WILL SUBMIT ANY CLAIMS ARISING OUT OF, RELATING TO, OR IN CONNECTION WITH THIS AGREEMENT OR THE INTERPRETATION, VALIDITY, CONSTRUCTION, PERFORMANCE, BREECH OR TERMINATION THEREOF, TO BINDING ARBITRATION AND THAT THIS ARBITRATION CLAUSE CONSTITUTES A WAIVER OF THE PARTY’S RIGHT TO A JURY TRIAL AND RELATED TO THE RESOLUTION OF ALL DISPUTES RELATING TO ALL ASPECTS OF THE RELATIONSHIPS BETWEEN THE PARTIES. * By sumbitting this form I agree to comply with Just Pet Me Country Club Rules and Regulations, as outlined in the Terms & Conditions of Service Agreement.