Agreement Forms | Apple Creek Canine Resort

ACCR FORMS

APPLE CREEK CANINE RESORT AGREEMENT FORM

Please complete the form below and our staff will follow up with any questions or concerns. Thank you!

Agreement Form Anchor

PET OWNER INFORMATION

Pet Owner #1

Pet Owner #2

Street Address

Address line 2

City

Zip

Contact Information

Phone #1

Whose Phone?

Phone #2

Whose Phone?

Phone #3

Whose Phone?

Phone #4

Whose Phone?

Email #1

Email #2

We use email solely for communication purposes- no ads, spam or sharing your info!

Preferred Method of Contact

Phone

EMERGENCY CONTACT

Please list an emergency contact that DOES NOT travel with you.

Emergency Contact #1

Emergency Contact #2

Phone #1

Phone #2

Is there anyone else allowed to pick your pup(s) up from Apple Creek Canine Resort ?

Name

Relationship

Name

Relationship

REFERRAL PROGRAM

Do you know about our Refer a Friend Program? If you refer someone to us and they book a day of daycare or boarding, your dog gets a FREE daycare visit! (Monday- Friday)

Who told you about us?

All services are scheduled by appointment so please give us a call at 319-784-7372 or email us at info@applecreekcanineresort.com to make or adjust any existing appointments. Please see our contact page for hours. For any same day cancellations or no-call/no-shows for daycare or spa only appointments, there will be a $30 charge. For any same day cancellations or no-call/no-shows for boarding appointments, there will be a $65 charge.

DOG'S INFORMATION

Name

Color/Markings

Spayed/Neutered

Yes

Veterinarian Office/ Clinic

Breed

Sex

Male

Female

Weight

Birthday

Vets Name

What name is your pup listed under at the vet?

At six months of age, the state of Iowa requires all dogs to be spayed or neutered in order to play with other dogs in a daycare facility. We offer one on one playtime with a staff member for pups who have not been spayed or neutered after that point. If your pup is in heat or begins a heat cycle, we will not be able to board them or have them attend daycare. If they go into heat while they are with us, we require a designated pick up person or we will take them to the vet to be boarded at owner’s cost.

BEHAVIOR AND PERSONALITY

How does your dog do when meeting new people? Select the best description(s) and leave any additional information below if needed.

Overly Friendly - jumps, very wiggly, excited

Curious but cautious

Indifferent

Timid- scared, overall uncertain, slow introduction needed

May bark, growl, or lunge

Any Addtional information

How does your dog do when meeting new dogs? Select the best description(s) and leave any additional information below if needed.

Overly Friendly - jumps, very wiggly, excited

Curious but cautious

Indifferent

Timid- scared, overall uncertain, slow introduction needed

May bark, growl, or lunge

Any Addtional information

How does your dog typically play with other dogs or people? Do they have a preference over who they play with? Select the best description and leave any additional information below if needed.

Adaptive - plays well with anyone

The People Pup - loves attention from people more than dogs

Cheerleader - usially on the outside of play, barking at others

The Lone Wolf - prefers to lounge, chew on bones etc

Rough Houser - wrestles, plays hard

Chaser - loves to run, chase or be chased

Any Additional information

What is your dog’s typical daily activity level like (going on walks, a dog park, attending daycare, going on car rides, etc.)? What is a normal day like for them?

Has your dog ever become protective/possessive over food, toys, or treats? Is it typically with other dogs or with people? If so, please explain:

Has your dog ever aggressively bitten another dog or a person? This alone may not prevent your dog from coming in. But we would like to know the details ahead of time to make sure we take the steps to prevent it from happening again. If yes, please explain:

Does your dog have any sensitivity to being touched on their head, paws, or around their collar? If yes, please explain:

Has your dog ever shown any signs of being afraid of thunder, fireworks, or other loud noises? If yes, please explain:

Has your dog ever jumped or climbed a fence? If yes, please explain:

FEEDING, MEDICATIONS, AND HEALTH:

Feedings: At ACCR, we do feedings at the following times: 6 am, 11 am, and 6 pm. Additional or altered feeding schedules are available. All food and treats must be sent in a resealable container (Ziploc bags preferred) either portioned out by meal or we can measure at each feeding. We will confirm feeding times, amount, and type of food at every check-in.

Time for meals:

Breakfast

Lunch

Dinner

Describe your dog's eating habits:

Grazer

Fast

Possssive w/humans

Times for treats:

Breakfast

Lunch

Dinner

Potty Breaks

Amount per feeding

Brand of food

Amount of treats per time:

Any special instructions for feeding or treats (specific times, preparation, refrigeration, etc.)?

MEDICATIONS

At ACCR, we do our medications at the following times: 6 am, 11 am, and 6 pm. As always, your pup’s health is our top priority and our staff is able to accommodate any times outside of these for administering time sensitive medications. All medications will be confirmed at every check-in, with new medications needing signed off by the owner to ensure we have everything listed correctly for their stay. Please send in all supplies used to administer medications (pill pockets, peanut butter, etc.). We will not leave medication unattended in a food bowl for safety purposes.

Medication Name:

Time(s) administered:

How much per dose?

How is it given?

Is this medication required to be given with food?

Yes

Is this medication only administered on an as needed basis? If so, what are we looking for prior to giving and how much are they able to have within a 24 hour period?

Medication Name:

Time(s) administered:

How much per dose?

How is it given?

Is this medication required to be given with food?

Yes

Is this medication only administered on an as needed basis? If so, what are we looking for prior to giving and how much are they able to have within a 24 hour period?

Medication Name:

Time(s) administered:

How much per dose?

How is it given?

Is this medication required to be given with food?

Yes

Is this medication only administered on an as needed basis? If so, what are we looking for prior to giving and how much are they able to have within a 24 hour period?

Medication Name:

Time(s) administered:

How much per dose?

How is it given?

Is this medication required to be given with food?

Yes

Is this medication only administered on an as needed basis? If so, what are we looking for prior to giving and how much are they able to have within a 24 hour period?

GENERAL HEALTH

Does your dog have any food sensitivities or allergies? If yes, what is it to and what does a reaction look like for them?

Does your dog have environmental or seasonal allergies? If yes, what is it to and what does a reaction look like for them?

Is your dog on a flea/tick preventative?

Yes

Any Addtional information

Has your dog ever had any major surgeries? If yes, what was it for and when did it happen? Is there anything we need to keep an eye on while they are in our care?

Has your dog ever been diagnosed with any major illnesses? If yes, what is it and when were they diagnosed? Are there any symptoms we need to watch for while they are with us?

Would you like ACCR to provide any of the following for you pup? Select all that apply:

Extra blankets – provided for dogs that may need some extra cushioning due to joint pain or issues.

A rubber mat – provided for dogs that may need help with traction when getting up.

Extra potty breaks - provided for dogs that may have urinary incontinence or still going through potty training.

We require all vaccinations to be administered by a veterinarian and ACCR must be provided with a copy from the vet clinic listing either the date administered or the expiration date. Vaccines updated after expiration are subject to a 7 to 14 day waiting period depending on the type of vaccine and how it is given. We have a full copy of our vaccination policy available on our website.

In Order for Apple Creek Canine Resort to accept my dog into their facility I agree to the following conditions:

Apple Creek Canine Resort Agreement Form

I agree my pet will be on a secure leash when arriving and departing Apple Creek Canine Resort.

Yes

I agree to schedule a specific time for drop off and pick up of my pet. If I do not pick up my pet as scheduled, additional charges may be billed for the additional time my pet remains at Apple Creek Canine Resort.

Yes

If my pet is not picked up within five days of their scheduled pick up, I agree the pet will become the absolute property of Apple Creek Canine Resort. All reasonable measures to reach owner and their emergency contacts will be made by ACCR

Yes

My pet has current Bordetella, Rabies and Distemper vaccinations. These vaccinations were administered by a licensed veterinarian or within the parameters of the Apple Creek Canine Resort vaccination policy. I will provide Apple Creek Canine Resort a copy of my pet’s current vaccination records. I understand a waiver can be secured for the distemper vaccination requirement provided my veterinarian provides written communication stating my dog should not receive the vaccine. Waivers cannot be secured for bordetella and rabies vaccines. I understand vaccinations must be updated prior to their date of expiration to avoid a waiting period between administration and my dog’s arrival at Apple Creek Canine Resort.

Yes

I agree if fleas or ticks are found on my pet while at Apple Creek Canine Resort, I will pay the cost of bathing my pet and additional kennel cleaning if needed to insure others are not exposed to the pests. Apple Creek Canine Resort will contact me in the event fleas or ticks are found.

Yes

I will not hold Apple Creek Canine Resort responsible for illness or the expense related to illness. I have read the information provided to me on the Apple Creek Canine Resort website and available in paper form in regard to CIRDC (Canine Cough). I understand some canine diseases are contagious and I assume the risk associated with my dog coming into close contact with other dogs while at Apple Creek Canine Resort.

Yes

As a Pet Owner, I understand I am responsible for any actions, claims, losses, damages, liabilities, and added expenses arising from my pets stay at Apple Creek Canine Resort. This included, but not limitedto, damage or injury to person property or animals. This release applies to and is binding upon my heirs, family members and anyone else asserting such a claim.

Yes

I agree to indemnify and hold harmless Apple Creek Canine Resort, its directors, officers, agents, employees and affiliates from any and all actions, claims, losses, damages, liabilties, and added expenses, including legal fees arising from my pets stay at Apple Creek Canine resort, or my violations of this agreeement.

Yes

If my pet becomes ill or injured, Apple Creek Canine Resort has my permission to consult my regular veterinarian or an emergency veterinarian and provide such care or treatment as may be recommended. I agree the expense for such consultation or necessary treatment will be paid by me (pet owner). In the event of this type of emergency, I will be notified by Apple Creek Canine Resort as soon as possible.

Yes

I understand, while highly unlikely, it is possible for elderly dogs to pass away while at Apple Creek Canine Resort. If this should happen, I will be contacted immediately. If I cannot be reached Apple Creek Canine Resort will call the emergency contact listed on my account. If neither party can be reached Apple Creek Canine Resort will contact my pet’s veterinarian. Immediate transport of my pet is required. Apple Creek Canine Resort will transport my pet to my veterinarian or the BluePearl Pet Hospital. A Trip Charge will apply.

Yes

My pet has not been sick in the last 14 days

Yes

My pet does not have open wounds or stiches

Yes

Medications/Ointments/Supplements:
I agree to provide all required medication/ointments/supplements my dog may need while at Apple Creek Canine Resort. Each time my dog arrives at Apple Creek Canine Resort, I will provide clear concise instructions for administering said products and confirm with a signature the information Apple Creek Canine Resort has on file is correct. I will bring prescription medication and supplements in its original container. I will provide a syringe for each administration of insulin to be injected, if my dog is diabetic.

Yes

I agree my pet will not be allowed to leave Apple Creek Canine Resort until all charges due are paid in full or both parties agree upon payment arrangements. If collection proceedings are necessary, I will be responsible for any and all attorney fees, regardless of whether an action is filed.

Yes

I understand prepaid daycare packages are nonrefundable and expire 12 months from purchase date. Discounted packages are provided only if they are paid for in advance.

Yes

Apple Creek Canine Resort has the right to take photographs and/or videos of Owner’s dog(s) while in the Facility’s care. Apple Creek Canine Resort may post or reproduce any and all photographs/videos taken (as well as dog(s) name) on or in, without limitation, website, social media sites or promotional materials without becoming liable to the Owner (or the Owner’s dog(s)) for any royalty payment. Owner hereby releases, covenants not to sue, and forever discharges the facility of and from any and all claims, demands, rights, and causes of action of whatever kind or nature.

Yes

If I request my dog receive Daycare playtime while at Apple Creek Canine Resort:

a. I understand Iowa State Code requires dogs 6 months of age and older to be spayed or neutered in order to play with other dogs. At Apple Creek Canine Resort, unaltered dogs under 6 months of age are allowed to play with other dogs. At 6 months of age they are welcome to join Daycare activities with a staff member.

b. Select that which applies

I agree my dog may play with other dogs

I agree my dog may play with sibling dogs from the same household

I agree my dog may play only with a staff person

c. Pursuant to Iowa Administrative Code Chapter 67.8(6)a(4) I understand the inherent risk of injury or disease when dogs owned by different people are allowed to commingle.

By signing below, I understand and approve the above terms and authorize Apple Creek Canine Resort to provide services for my dog.

First and Last name of Pet Owner

Date

650 51st Street | Marion, IA 52302

(319) 784-7372

ACCR FORMS

APPLE CREEK CANINE RESORT AGREEMENT FORM

PET OWNER INFORMATION

Contact Information

EMERGENCY CONTACT

Please list an emergency contact that DOES NOT travel with you.

Is there anyone else allowed to pick your pup(s) up from Apple Creek Canine Resort ?

REFERRAL PROGRAM

Do you know about our Refer a Friend Program? If you refer someone to us and they book a day of daycare or boarding, your dog gets a FREE daycare visit! (Monday- Friday)

DOG'S INFORMATION

BEHAVIOR AND PERSONALITY

FEEDING, MEDICATIONS, AND HEALTH:

MEDICATIONS

GENERAL HEALTH

In Order for Apple Creek Canine Resort to accept my dog into their facility I agree to the following conditions:

Apple Creek Canine Resort Agreement Form

If I request my dog receive Daycare playtime while at Apple Creek Canine Resort:

c. Pursuant to Iowa Administrative Code Chapter 67.8(6)a(4) I understand the inherent risk of injury or disease when dogs owned by different people are allowed to commingle.

By signing below, I understand and approve the above terms and authorize Apple Creek Canine Resort to provide services for my dog.

650 51st Street | Marion, IA 52302

(319) 784-7372

ACCR FORMS

APPLE CREEK CANINE RESORT AGREEMENT FORM

PET OWNER INFORMATION

Contact Information

EMERGENCY CONTACT

Please list an emergency contact that DOES NOT travel with you.

Is there anyone else allowed to pick your pup(s) up from Apple Creek Canine Resort ?

REFERRAL PROGRAM

Do you know about our Refer a Friend Program? If you refer someone to us and they book a day of daycare or boarding, your dog gets a FREE daycare visit! (Monday- Friday)

DOG'S INFORMATION

BEHAVIOR AND PERSONALITY

FEEDING, MEDICATIONS, AND HEALTH:

MEDICATIONS

GENERAL HEALTH

​

In Order for Apple Creek Canine Resort to accept my dog into their facility I agree to the following conditions:

Apple Creek Canine Resort Agreement Form

If I request my dog receive Daycare playtime while at Apple Creek Canine Resort:

c. Pursuant to Iowa Administrative Code Chapter 67.8(6)a(4) I understand the inherent risk of injury or disease when dogs owned by different people are allowed to commingle.

By signing below, I understand and approve the above terms and authorize Apple Creek Canine Resort to provide services for my dog.