Walk-in intake & signature sheet (v3 — pre-priced chart)

Castle Rock Kennels

3113 Sunshine Coast Highway · Roberts Creek, BC · V0N 2W4
(604) 885-9840 · my.castlerockkennels.ca

Walk-in intake & signature sheet · v1.0 · used until customer signs up online Keep together with the laminated Service Agreement

Date

Staff init

Booking ref (staff)

1 · Owner

Full legal name

Phone

Cell

I am 19+ & authorised to bind co-owners

YES

2 · Emergency contact & vet

Emergency contact name

Phone

Relationship

Vet clinic name

Vet phone

3 · Dog staying (use a 2nd sheet for a 2nd dog)

Name

Breed

Age

Wt (lb)

Sex

Neutered

Good with other dogs?

YESNOUNKNOWN

Vacc current (rabies / DA2PP / Bordetella / parasite)?

YES — proof attachedNO

Meds / special diet / allergies

Behaviour notes (bite history, anxiety, escape)

Items brought in (bedding, toys, leash, food container)

4 · Stay details

Service

🌙 Boarding — overnight ☀️ Daycare — same-day

Drop-off date

Time

Morning (7:30–10) Other

OUT

Pick-up date

Time

Afternoon (4–6) Other

Staff use only — customer skips this part

Circle the stay total — and the 🍖 food row if we supply food. G.S.T. already included in every number.

Rate	1 night/day	2	3	4	5	6	7
🌙 Boarding $40/night	42.00	84.00	126.00	168.00	210.00	252.00	294.00
🌙 Boarding ×2 dogs $60/night	63.00	126.00	189.00	252.00	315.00	378.00	441.00
☀️ Daycare $30/day	31.50	63.00	94.50	126.00	157.50	189.00	220.50
☀️ Daycare ×2 dogs $25/dog	52.50	105.00	157.50	210.00	262.50	315.00	367.50
🍖 + Kennel food $10/day — add to total	10.50	21.00	31.50	42.00	52.50	63.00	73.50

Extras / custom: 🕧 Late pickup (after 11 AM) +$31.50 incl. Other $ (vet / custom, incl. G.S.T.)

=TOTAL $

Payment Cash Visa / MC Debit Cheque #__________ G.S.T. # 86280 8920 RT0001

5 · Emergency vet authorisation & critical-care election (required)

If urgent vet care is needed and we cannot reach you OR your emergency contact, we will seek care up to the dollar amount you authorise.

Authorise up to ($ CAD)

Critical-care election (vet judges suffering irreversible AND you cannot be reached)

Authorise humane interventionDo NOT authorise — supportive care only

Acknowledgement. By signing below I confirm that: (a) I have read the laminated Castle Rock Kennels Service Agreement v1.0 provided to me at drop-off — including the Release of Liability in §5 (which releases the kennel for its own ordinary negligence) and the Indemnification in §6; (b) I am 19+ and authorised to bind any co-owners; (c) every answer above is true and accurate; (d) my signature has the same legal effect as a handwritten signature.

Customer signature

Print name

Date

🐾

Skip this form next time — sign up free at my.castlerockkennels.ca Sign once, confirm at every future booking with one tap. Get photos of your dog's stay. Ask staff to text you the sign-up link before you leave today.

Service Agreement v1.0 · sheet retained in customer file for 7 years per Privacy Notice §2 · Castle Rock Kennels, Roberts Creek BC