Stream Valley Veterinary Hospital

42902 Waxpool Road
Ashburn, VA 20148-4525

(703)723-1017

streamvalleyvet.com

Consent for Dog Walking / Group Play / Agility
and
Release and Waiver of Liability for Dog Walking / Group Play / Agility

I give Stream Valley Veterinary Hospital ("Hospital"), Dr. Mary Corey, and her employees permission to have my dog participate in group play as deemed safe and appropriate by the Hospital's staff.  I understand that my dog must have had its entire series of examinations, vaccinations, and parasite screenings completed prior to being accepted for daycare.  I consent to the related charges and agree to pay as charges are incurred.

I acknowledge that my dog has been and is trained to walk on a leash and that I know of no tendency of my dog to pull off the leash or attack people, dogs, or other animals when on a leash.  I am aware and understand that there are risks involved with group play, including but not limited to minor injury, injury by other animals, and even death.  I expressly and knowingly accept and assume the risk of injury or death to my dog due to reasonable acts and reasonable standards of care by the Hospital, its agents, employees, officers, directors, members, and staff, but I do not assume such risk as to grossly negligent acts of the Hospital, its agents, employees, officers, directors, members, and staff.

I also give the Hospital, Dr. Mary Corey, and her employees permission to exercise my dog utilizing standard agility equipment as deemed safe and appropriate by the Hospital's staff. I acknowledge that my dog is in good health, has had a health exam within the last six months, and is capable of participating in these exercises.  I am aware of and understand the risk involved with the practice of agility, including by not limited to athletic/orthopedic injury, blunt or sharp trauma, and falls.

With the knowledge of the foregoing, and as an inducement for the Hospital to have my dog participate in group play and exercise, I hereby knowingly agree and expressly and irrevocably waive and/or release any and all rights that I, my spouse, my heirs, my personal representatives, my successors and assigns may have to make a claim against the Hospital, its agents, employees, officers, directors, members, and staff.


BY SIGNING THIS WAIVER AND RELEASE, I UNDERSTAND THAT I AM KNOWINGLY AND IRREVOCABLY GIVING UP (WAIVING AND RELEASING) ANY RIGHT I MIGHT HAVE TO SUE OR MAKE A CLAIM WHICH I MIGHT HAVE OR WHICH MIGHT SUBSEQUENTLY ARISE OR OCCUR AGAINST THE HOSPITAL AND THE HOSPITAL'S EMPLOYEES, AGENTS, OFFICERS, AND STAFF OR ITS BOARD OF DIRECTORS, OR ANY LANDOWNERS, THEIR FAMILIES, EMPLOYEES OR TENANTS, OVER WHOSE LAND MY DOG IS WALKED, FOR ANY INJURIES MY DOG MIGHT SUSTAIN WHILE BEING EXERCISED ON THE PROPERTY, AND THAT I AM INDEMNIFYING AND HOLDING HARMLESS THE HOSPITAL, ITS BOARD OF DIRECTORS, EMPLOYEES, AGENTS, OFFICERS, AND STAFF, AND/OR ANY LANDOWNERS, THEIR FAMILIES AND TENANTS, OVER WHOSE LAND MY DOG IS WALKED FOR MY DOG INJURING ANYONE ELSE OR ANOTHER ANIMAL WHILE SO ENGAGED.  IT IT MY INTENT TO GIVE UP THOSE RIGHTS AND PROVIDE THIS HOLD HARMLESS AGREEMENT, AND I DO SO KNOWINGLY AND VOLUNTARILY.

SEEN, AGREED AS TO CONDITIONS AND COSTS, AND LIABILITY WAIVER HEREBY GRANTED TO DR. MARY COREY, STREAM VALLEY VETERINARY HOSPITAL, AND ALL ITS EMPLOYEES AND AGENTS:


I have read the above conditions, understand and agree to them.  If I neglect to pick my pet up within seven (7) days after drop off, you shall assume that the pet is abandoned, and you are hereby authorized to place the pet as deemed necessary.  I understand this does not release me from any incurred charges.


Signature_________________________________

Date_________________

Daycare Admission

Client Name (required)
First Name (required)
Last Name (required)
Emergency Contact Number (required)
Phone TypePhone Number (required)
Pet Name (required)

Breed (required)

Sex (required) :
Color (required)

Weight (required)

Does your dog play well with other dogs? (required) :
Special Needs / Diet

Fees per Day:
Summer $35.00 / day (Memorial Day thru Labor Day) Winter $30.00 / day (Labor Day thru Memorial Day)
Payment Preference:
I prefer to pay daily
I prefer to pay weekly
Availability and Hours
Please note: Daycare is available as space allows. During the winter season, daycare may be scheduled several days, or possibly weeks, in advance. However, during the summer months, daycare may only be scheduled on a same-day basis. Daycare is not available on holidays or similar busy kennel times (ie: Loudoun County Public School Spring Break, etc.). Normal daycare hours are Monday through Friday, 7 am to 7 pm. Please do not hesistate to call for further information or for scheduling.
Routine Day includes:
Meet the staff; individual play -- Morning snack & radio (Hills treats unless otherwise supplied by owner) -- Group play (if compatible; see further Release and Waiver information above) -- Lunch, if requested (Science Diet Maintenance unless otherwise supplied by owner) -- Nap with radio -- Playtime before pick up
Optional Services:
Spa bath (price varies with breed) -- Weight Loss Program with weigh-ins (with consultation and under supervision of medical staff; additional cost) -- Water play (seasonal)
Current Vaccinations:
We believe every guest has the right to be protected from infectious and contagious diseases. Therefore, all patients must have current vaccinations (1- or 3-year rabies, 1- or 3-year distemper, 6-month bordetella, 1-year canine influenza). If vaccines are not on record and proof of vaccines is not provided, your pet will be examined and vaccinated, and you will be charged.
Parasites:
We believe every guest has the right to be free of external (ie: fleas, ticks, & mites) and internal (ie: heartworms, intestinal worms) parasites. If your pet is not on flea prevention, it will be administered during stay, and you will be charged. If your pet has not had a heartworm test or fecal exam within the last year, we will test your pet at your cost. If your pet is infested, treatment will be prescribed as appropriate, and you will be charged.
Emergency Services:
It is our responsibility to provide emergency treatment should the need arise. We will contact you (if possible) if the problem is serious; if a minor problem, we will treat according to the best interests of the patient. Fees for emergency services will be due when your pet goes home.
Please Read:
I have read and understand the above Release and Waiver information. I understand that I will be asked to sign, in person, a copy of the above Release and Waiver at the time of my pet's first daycare drop-off, regardless of group play compatibility. I have provided the information on this form to the best of my knowledge and ability.
I agree

Check the reCAPTCHA to ensure you are not a robot: