Reservations

Terms and Conditions

Date
New Client Agreement
I hereby certify my dog(s) is/are in good health and has/have not been ill with any communicable conditions within the last 7 days. I further certify that my dog/dogs has/have not shown aggression or threatening behavior toward any person or other dog. I have read and understand the following: 1) I understand that I am solely responsible for any harm caused by my dog/dogs while my dog/dogs is/are attending Kota’s Place. 2) I further understand and agree that in admitting my dog/dogs to Kota’s Place, the Kota’s Place staff have relied on my representation that my dog/dogs is/are in good health and has/have not harmed or shown aggression or threatening behavior toward any person or other dog. 3) I further understand and agree that Kota’s Place and their staff and volunteers will not be liable for any problems that develop provided reasonable care and precautions are followed, and I hereby release them of any liability of any kind whatsoever arising from my dog/dogs attendance and participation at Kota’s Place 4) I further understand and agree that dogs can sometimes receive minor cuts and scratches at daycare and any problems that develop with my dog/dogs will be treated as deemed best by staff and volunteers of Kota’s Place, at their sole discretion, and that I assume full financial responsibility for any and all expenses involved.*
- Yes
Emergency Veterinarian Care
1) Should your pet require emergency medical attention while being boarded, your pet will be treated at the closest emergency room. You are responsible for all medical expenses incurred as well as a $15.00 transportation fee. 2) I understand that Kota’s Place will try to contact all necessary people prior to taking your dog to a pet professional. Kota’s Place will exercise the option to proceed if no one is available and you (the client) will incur the cost of any and all vet services, the cost of which the undersigned agrees to reimburse Kota’s Place at the time of pick-up. 3) If Kota’s Place discovers that your dog is not up to date with shots, or has never had their shots, we reserve the right to take your dog/dogs to the vet of our choice and have your dog’s shots updated at your expense plus the cost of transportation. Dogs showing infestation of fleas and tics will be shampooed and treated at owners’ expense. We make every effort to maintain a flea/tic free environment however we cannot be responsible for occasional occurrences. 4) If I am unable to pick up my dog for any reason, I agree to contact Kota’s Place immediately, and agree to pay any/all additional fees incurred. Payment Policy: First time clients, we require full payment at the time of drop-off. I agree to pay any additional cost and attorney fees necessary for the collection of any amount not paid in full.*
- Yes
I hereby certify that I am at least 18 years of age or older and by placing my name here, I agree to the terms of the above Boarding/Daycare contract.*
First Last
Captcha

Have You Read & Signed the Terms and Agreements?*

Yes
No

Customer Information

Name*

First Last

Main Phone*

Spouse / Partners Name*

First Last

Spouse's Phone*

Your Address*

Street Address Address Line 2 City State ZIP Code

Email*

Emergency Contact Info*

First Last

Contact's Phone*

How did you hear about us?*

Facebook / Social Media
Referral / Word of Mouth
Radio
TV
Print Media

How many dogs will you be registering?*

Please enter a value between 1 and 5.

Puppy 1 Information

Please tell us more about your dog.

Name*

Puppy's Name

Gender*

Male
Female

Spayed / Neutered*

Spayed
Neutered

Breed*

Color

Birthday*

Puppy 2 Information

Please tell us more about your 2nd dog.

Name*

2nd Puppy's Name

Gender*

Male
Female

Spayed / Neutered*

Spayed
Neutered

Breed*

Color

Puppy 2 Birthday*

Puppy 3 Information

Please tell us more about your dog(s).

Name*

3rd Puppy's Name

Gender*

Male
Female

Spayed / Neutered*

Spayed
Neutered

Breed*

Color

Birthday Puppy 3*

Puppy 4 Information

Please tell us more about your dog.

Name*

4th Puppy's Name

Gender Puppy 4*

Male
Female

Spayed / Neutered*

Spayed
Neutered

Breed*

Color

Birthday Puppy 4*

Puppy 5 Information

Please tell us more about your dog.

Name*

5th Puppy's Name

Gender Puppy 5*

Male
Female

Spayed / Neutered*

Spayed
Neutered

Breed*

Color

Birthday Puppy 5*

Puppy Picture*

Drop files here or

Please upload a picture of your puppy for our records! If you are registering more than one puppy, please upload one picture of each here.

Have you scheduled the initial meet and greet for your dog(s)?*

Yes
No

Please schedule your interview here!

Meet & Greet Appointment

Intitial Interview Scheduling Appointment

Client's Name*
First Last
Cell Phone Number*
Email Address*
Enter Email Confirm Email
How Many Puppies Will You Be Bringing?*
Please enter a value between 1 and 5.
Puppy One's Name*
Puppy
Puppy Two's Name*
Puppy
Puppy Three's Name*
Puppy
Puppy Four's Name*
Puppy
Puppy Five's Name*
Puppy
What day would you like to come in?*
What time?*

: HH

MM
Phone
This field is for validation purposes and should be left unchanged.

Feeding Schedule

Is the feeding schedule the same for all of your dogs?

Yes
No

Brand of Food

Am Feeding Schedule Quantity / Instructions*

Pm Feeding Schedule Quantity / Instructions*

Multi-Dog Medical Info will be collected at the office.

Please bring this information with you at the Meet and Greet for your dogs. Thank you!

Medical Information

Special Medications,treatments,allergies or other health issues?*

(hip dysplasia, hotspots, temperament, etc.) Please include all - or say "None"

Any Medications*

Dosage / Form*

How much and is it a pill / liquid / shot? Please keep all medication in their original Vet administered containers with directions.

Is your dog diabetic?*

Yes
No

Frequency of Shots?

Multi-Dog Vaccine Info will be collected at the office.

Please bring this information with you at the Meet and Greet for your dogs. Thank you!

Vaccine Information

We REQUIRE current vet administered vaccines for ALL DOGS. For one dog, please send your forms via the upload button below.

Would you like to upload your Vaccine Files?*

Upload Now
I'll Bring them in

You can upload your files here or bring them during you initial Meet and Greet interview.

Vaccine Files*

Drop files here or

1) Rabbies, 2) Parvo/Distemper 3) Bordatella (kennel cough)

Flea and Tic Treatment

For the protection of all of our guests, we require all dogs have a flea and tic treatment upon admission to Kota's Place. Kota's Place uses Frontline treatment and will provide the initial treatment for $20.00.

Will your dog require a tic/flea treatment?*

Yes
No

Will you provide the treatment?*

Yes
No

We will provide a treatment for $20.00

Captcha

Phone

This field is for validation purposes and should be left unchanged.

Reservations

New Client Application

Terms and Conditions

New Client Agreement

Emergency Veterinarian Care

Customer Information

Puppy 1 Information

Puppy 2 Information

Puppy 3 Information

Puppy 4 Information

Puppy 5 Information

Meet & Greet Appointment

Feeding Schedule

Multi-Dog Medical Info will be collected at the office.

Medical Information

Multi-Dog Vaccine Info will be collected at the office.

Vaccine Information

Flea and Tic Treatment

Kota's Kab

Meet & Greet Appointment

First Dog Services

Additional Dog(s) Services