Ruff Club Application Step 1 of 4 25% Emergency ContactsWho is your emergency contact & is authorized for pickup?*Their NameRelationship to OwnerTelephone Number Dog InformationName* Breed* Gender* Male Female NYC Dog License No. ( If Any ) Approx. Date of Birth* Color / Markings* Weight (in hounds, ahem pounds)*Please enter a number only. eg. "28" Health ProfileDog Vaccination RecordsAccepted file types: pdf, doc, docx, jpg, jpeg, gif, png, rtf, , Max. file size: 4 MB.Veterinarian* Veterinarian Telephone* Is your Dog Spayed/Neutered?* VACCINATION INFORMATION: Please upload your pet's most recent vaccination records, including a Rabies CertificateRabies : MM slash DD slash YYYY (Expiration Date)Distemper/Parvo: MM slash DD slash YYYY (Expiration Date)Bordtella: MM slash DD slash YYYY (Date Given) The NYC Department of Health requires a Bordetella Booster every six months.Please list all Health Issues (ALLERGIES, BACK, EYES, HEARING, DIABETES, OTHER) Feeding InstructionsWET Brand WET Amount DRY Brand DRY Amount Feeding Frequency (Check) AM (24-hour care only) MD (12-1 pm) PM (5-6 pm) Additional Feeding InstructionsMedication InstructionsMedication NameInstructions (frequency, amount, how to give) What are the reasons and approximate dates for your last three vet visits?ReasonApproximate Date How long have you had your dog?* Has your dog ever attended dog daycare? If so, where?* Has your dog ever been boarded? If so, where?* Has your dog ever bitten another dog? Please describe the circumstances.*What else can you tell us about your dog?Does your dog have any fears, separation anxiety or issues with certain types of dogs or humans? Please describe if so.*Does your dog socialize regularly with other dogs, either at the dog run or another daycare?* Yes No Terms & ConditionsPlease agree to our termsTerm 1* The information I have provided is true and correct. Term 2* I agree to pay for services when they are reserved or rendered. I authorize Ruff Club LLC, its affiliates, and its subsidiaries ("Ruff Club") to charge balances for past due services to the credit card on file according to Ruff Club's policies. Term 3* I authorize Ruff Club and its employees to take whatever action they deem reasonably necessary to ensure the safety, security, and health of my dog(s) while under Ruff Club's care. Term 4* I authorize Ruff Club and its employees to walk my dog off-premises in public streets and parks in the vicinity of Ruff Club. Term 5* Except to the extent caused by Ruff Club's gross negligence, bad faith, or intentional misconduct, I agree to hold harmless and indemnify Ruff Club and its agents and employees from all liabilities, financial or otherwise, for injuries to myself, my dog(s), or my property, which may arise from services rendered by Ruff Club or as a consequence of my or my dog's association with Ruff Club. Term 6* Except to the extent caused by Ruff Club's gross negligence, bad faith, or intentional misconduct, I waive, to the maximum extent permitted by law, any and all claims, actions, or demands of any nature, either foreseen or unforeseen, that I may have against Ruff Club and its agents and employees. Term 7* I acknowledge that I have read this agreement and release of liability in its entirety and agree to its terms. I understand that this agreement shall control every time Ruff Club reserves or renders services on my behalf.