Beaverdam Kennels Release Form

Name *
Address *
Home Phone *
Home Phone
Cell Phone
Cell Phone
Are All Vaccinations Current? *
I Agree To The Below Terms & Conditions *


  1. For each day that the above animal is on premises at Beaverdam Kennels, I agree to pay $40 to Beaverdam Kennels as a boarding/training fee.

  2. Payments are to be made in advance prior to the first of each month. Late payments will be subject to a $50 late charge and the dog will not be trained until payment is received. A boarding fee of $45 per day will be charged until the training fees are received. If payment is not received by Beaverdam Kennels by the 3rd of the month, I authorize Beaverdam Kennels to charge the credit card listed below for the current month's fees.

  3. Failure to pay for two months will result in the sale of the animal for fees due.

  4. In case of an emergency, the dog will be taken to a local animal hospital. All veterinary charges will be the responsibility of the owner.

  5. Any dog that bites while at Beaverdam Kennels shall be removed immediately. Beaverdam Kennels and it's employees will not be held responsible for any actions that occur during a bite incident.

  6. Accounts will be paid in full before any dog leaves Beaverdam Kennels.

  7. Beaverdam Kennels will not be responsible for heartworm treatment.

Pursuant to completion and transmission of this form, I have read and agree to the above terms and hereby waive and release any and all claims and hold harmless Beaverdam Kennels, Charles Jurney, and family and any other person connected with Beaverdam Kennels, I , or anyone claiming by or through me, now have or may hereafter acquire for damages, accidental injury (such as but not limited to infection, heartworm infestation, cuts, scratches, sores, bites, broken bones, accidental breeding, etc.), accidental loss ( such as but not limited to disappearance, runaway, theft, fire, etc) or death resulting from or arising out or boarding or training at Beaverdam Kennels.