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Form

Hi, I'm KANE9.

Welcome to Kane9's Registration Page!

Client Intake Sheet

Owner 1 Last Name
Last Name
Field is required!
Field is required!
Owner 2 Last Name
Last Name
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Field is required!
Address
Your Address
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Field is required!
Instagram or Facebook
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Field is required!
Owner 1 Work Phone
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Field is required!
Owner 1 Cell Phone
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Field is required!
Preferred contact method:
Field is required!
Field is required!
Emergency Contact
Last Name
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Field is required!
Email
E-mail Address
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Field is required!
Home Phone
Field is required!
Field is required!
Alarm Company
Field is required!
Field is required!
Code Word
Code Word
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Field is required!
First Name
First Name
Field is required!
Field is required!
First Name
First Name
Field is required!
Field is required!
Email
Your E-mail Address
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Field is required!
Home Phone
Field is required!
Field is required!
Owner 2 Work Phone
Field is required!
Field is required!
Owner 2 Cell Phone
Field is required!
Field is required!
Emergency Contact
First Name
Field is required!
Field is required!
Address
Your Address
Field is required!
Field is required!
Cell
Field is required!
Field is required!
Phone
Field is required!
Field is required!
Gate/Door Code
Field is required!
Field is required!
Please list the location of the following:
Leash/Collar
Field is required!
Field is required!
Medications
Field is required!
Field is required!
Breaker Box
Field is required!
Field is required!
Cleaning Supplies
Field is required!
Field is required!
Ok to contact family Vet in emergency? (Please see Veterinary Authorization Form)
Field is required!
Field is required!
Food/Toys
Field is required!
Field is required!
Brush/Towel
Field is required!
Field is required!
Water Shut Off
Field is required!
Field is required!
Fire Extinguisher
Field is required!
Field is required!
If unavailable, ok to contact another vet?
Field is required!
Field is required!

Disclaimer & Waiver of Liability:

The information I have given in this application is true, correct and complete to the best of my knowledge. I have read and agree to abide by the Terms and Conditions for services received from Kane9 Animal & Home Care Services. I hereby indemnify Kane9 Animal Care Services and their staff against liability of any kind whatsoever arising from my dog’s participation in any services offered by Kane9 Animal & Home Care Services.
Owner
Field is required!
Field is required!
Date
Owner
Select a date
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Field is required!
Pack Leader
Field is required!
Field is required!
Date
Pack Leader
Select a date
Field is required!
Field is required!

Off the Lead Consent Form:

I agree to Kane9 Animal & Home Care Services having the right to allow my dog off the lead and understand that all terms and conditions remain the same.
Name
Field is required!
Field is required!
Date
Select a date
Field is required!
Field is required!

Key Holder Disclaimer & Waiver of Liability:

I have read and agree to abide by the Terms and Conditions for services received from Kane9 Animal & Home Care Services. I understand that this form acts as permission to hold keys to my property, which I have provided willingly. I hereby indemnify Kane 9 Animal & Home Care Services and their staff against liability of any kind whatsoever arising from damage or loss of any property.
Name
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Field is required!
Date
Select a date
Field is required!
Field is required!

Pet Information

Client
Field is required!
Field is required!
Pet 1 Name
Name
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Field is required!
Date Of Birth
Date Of Birth
Field is required!
Field is required!
Colour
Field is required!
Field is required!
Last Vaccinations
Select a date
Field is required!
Field is required!
License # (Dogs)
Field is required!
Field is required!
Breed
Breed
Field is required!
Field is required!
Gender
  • - select gender -
  • Male
  • Female
- select gender -
Field is required!
Field is required!
Spayed/Neutered
Field is required!
Field is required!
Allergies
Field is required!
Field is required!
Pet 2 Name
Name
Field is required!
Field is required!
Date Of Birth
Select a date
Field is required!
Field is required!
Colour
Field is required!
Field is required!
Last Vaccinations
Select a date
Field is required!
Field is required!
License # (Dogs)
Field is required!
Field is required!
Breed
Breed
Field is required!
Field is required!
Gender
  • - select a option -
  • Male
  • Female
- select a option -
Field is required!
Field is required!
Spayed/Neutered
Field is required!
Field is required!
Allergies
Field is required!
Field is required!
Pet 3 Name
Name
Field is required!
Field is required!
Date Of Birth
Select a date
Field is required!
Field is required!
Colour
Field is required!
Field is required!
Last Vaccinations
Select a date
Field is required!
Field is required!
License # (Dogs)
Field is required!
Field is required!
Breed
Breed
Field is required!
Field is required!
Gender
  • - select a option -
  • Male
  • Female
- select a option -
Field is required!
Field is required!
Spayed/Neutered
Field is required!
Field is required!
Allergies
Field is required!
Field is required!
Any pre-existing/current health conditions? Please List:
Field is required!
Field is required!
Any restrictions on your dogs activity? Please List:
Field is required!
Field is required!
Please describe general behaviour and energy levels:
Field is required!
Field is required!
Does your dog play off lead with other dogs?
Field is required!
Field is required!
Has your dog ever jumped on, growled at, or bitten anyone? (if so, please describe circumstances)
Field is required!
Field is required!
Has your dog ever bitten another dog, other than play-biting? (if so, please describe circumstances)
Field is required!
Field is required!
Does your dog respond to any specific or unique commands?
Field is required!
Field is required!
Submit