Montana Water Dogs
We will use this form to keep up to date on your Pet. Once you fill it out, please bookmark it and update it whenever necessary.
Email address *
Kona
Services Required *
Please tell us what services you are looking for
Required
Has your dog ever swam before ?
Your answer
Does your dog like to swim ?
Your answer
Does your dog like baths ?
Your answer
How often does your dog get groomed/brushed/nails trimmed?
Your answer
Has your dog ever worn a life vest ?
What areas are sensitive on your dog?
Your answer
Will your dog handle being lifted in and out of the pool if needed and turned in the pool?
Your answer
What is your dog's current activity?
Your answer
Pet Name and Breed *
We do prefer that a separate profile be completed for each pet.
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Date of birth for your your Pet *
Your answer
How much does your pet weigh? *
Your answer
Sex *
Owner first and last name *
Your answer
Street Address *
Your answer
City, State and Zip code *
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Telephone Number (cell and home) *
Your answer
Owner Email *
Your answer
Vaccinations / Health
Vaccinations *
Please check to verify that applicable vaccinations and licenses are current, as required by Missoula. WE MUST BE ABLE TO VERIFY RECORDS.
Required
Overall Health *
Please tell us about your pets overall health and physical condition.
Your answer
Fears, Phobias, and Reactions
Aggression towards animals
On a scale from 0 to 10, with 0 being none, and 10 being very aggressive, tell us if your pet is agressive towards other animals
No agression
Very aggressive
Aggression towards people
On a scale from 0 to 10, with 0 being none, and 10 being very aggressive, tell us if your pet is aggressive towards people
No aggression
Very aggressive
Treats
Please tell us if treats can be feed during their water therapy session?
Feeding Times *
Your answer
Dietary concerns *
Please discuss in detail any allergies and/or dietary concerns your pet has.
Your answer
Medications/Treatments
Please discuss in detail, the medications, ointments, and treatments your pet receives. If more than one of your pets receives medications, please mark the appropriate containers with their name.
Your answer
Anything else we need to know about your pet ?
Tell us anything you want us to know about your pet here.
Your answer
Night and Day accommodations *
Please tell us where your pet is to stay, during the day, and at night. Does your pet stay in a kennel?
Your answer
Vet for your Pets *
Please enter the name and telephone number of your veterinarian. If you don't have a current local vet, we still need the name and number of your previous vet to be able to verify vaccines, thank you!
Your answer
B. Has your pet ever: *
Check as many as apply, and if any are checked, please check and elaborate under "Other".
Required
I, the owner of the above listed pet, hold Varen Chapman harmless if my pet exhibits any of the above listed behaviors in item B. I further agree to participate in the solution and/or resolution of any situation that arises from my pet exhibiting any of the above behaviors, including a financial or legal solution. I agree to pay any citations, should they arise. *
If No is checked, please tell us what your solution should be for any of these situations arise.
I acknowledge that I have voluntarily applied to enter my dog into care and/or activities with Varen Chapman *
I understand that even with proper care and supervision dogs can be injured, can die or run away. If while in the custody of Varen Chapman, if my pet is injured, dies or runs away, I waive any claim against Varen Chapman or her employees or other agents for any claims, damages or other liability based upon that injury, death or escape. I understand that even with proper care and supervision a dog can injure another dog or person or can damage property. If while in the custody of Varen Chapman my pet injures another dog or person or damages property, I will indemnify Varen Chapman, its owners and employees or other agents from any claims, damages or other liability based upon that injury or damage. I also understand that should my dog become destructive, a nuisance, uncontrollable, or become stressed while in the custody of Varen Chapman, that she and/or their employees can refuse service. I have read this Certification, fully understand its meaning and agree to my commitments in the Certification as a condition to Varen Chapman's acceptance of my pet in its custody.
Authorization for Treatment - Type Name and Date to Electronically Sign *
I understand that Varen Chapman may need to obtain medical care for my pet, and I expressly agree and allow Varen Chapman to obtain this care on my behalf.
Your answer
Verification of Form *
I, the owner of the above listed pet warrant that the information contained herein is true and correct to the best of my knowledge. If any of the information is found to be untrue, I accept all responsibility of the consequences. I also affirm that I understand the policies as stated here, and on the website.
How did you hear about us ?
Check as many as apply, and if any are checked, please check and elaborate under "Other".
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