Registration Form – Berkshire Barks Dog Walking Machine

Dog's Name(s)

Name

Address

Postcode

Mobile

2nd Contact Name

2nd Contact Number

Vet's Name

Vet's Address

Vet's Number

Dog's Age

Dog's Breed and Colour

Is Your Dog Microchipped?

Yes No

Is Your Dog Insured?

Yes No

Is Your Dog Neutered?

Yes No

In The Case of an Un-neutered Bitch, When Was She Last in Season?

Is Your Dog Up to Date With Shots/Immunisations?

Yes No

When Was Their Last Kennel Cough Injection?

Please list any pre-existing or current health issues, including allergies

Please list any medication your dog is taking

Please provide details if your dog is anxious around, or frightened by, any of the following:

Describe below

Can your dog go off lead? If so, what is their recall?

How Does Your Dog Behave Around Other Dogs?

How Does Your Dog Behave Around Livestock?

How Does Your Dog Behave Around Children?

Has your dog ever bitten someone? (if so, please describe the circumstances)?

Has your dog ever bitten another dog?(if so, please describe the circumstances)?

Please give any other information that you think would be useful to enable us to give your dog the best possible care while under our care?

Disclaimer and Waiver of Liability

The information I have given in this application is true, correct and complete to the best of my knowledge.I have read and agree to abide by the Terms and Conditions for services received from Berkshire Barks. I hereby indemnify Berkshire Barks and their staff against liability of any kind whatsoever arising from my dog’s participation in any services offered by Berkshire Barks.

Off Lead Consent:

I agree to Berkshire Barks having the right to allow my dog off the lead and understand that all terms and conditions remain the same.I have read and agree to abide by the Terms and Conditions for services received from Berkshire Barks. I hereby indemnify Berkshire Barks and their staff against liability of any kind whatsoever arising from my dog’s participation in any services offered by Berkshire Barks.

Key Holder Disclaimer & Waiver of Liability

The information I have given in this application is true, correct and complete to the best of my knowledge.I have read and agree to abide by the Terms and Conditions for services received from Berkshire Barks. I understand that this form acts as permission to hold keys to my property, which I have provided willingly. I hereby indemnify Berkshire Barks and their staff against liability of any kind whatsoever arising from damage or loss of any property.

Please attach copies of your dog’s most recent vaccination certificates, including kennel cough (bordetella)

Signed

Date