Forms...
ABOUT YOU
First Name:
Last Name:
Street Address:
Apartment:
City:
State:
Zip:
Daytime Phone # :
Evening Phone # :
Email Address:
Other Authorized Name:
Emergency
Instructions:
Where Did You Hear
About Us?
ABOUT YOUR PET
Your Pet's Name(s):
Breed(s):
Sex:
Date of Birth/Age:
Color:
Weight:
Spayed/Neutered:
If female unspayed,
date of last cycle:
Does your pet get
along with other pets?
Does your pet get along
with other people?
Under what
circumstances does
your pet snarl, bark, or
cry?
Has your pet ever
bitten or been bitten?
Does your dog use
public dog runs?
Has your pet used a
daycare/boarding
facility before?
Regular Food - Brand:
Variety:
Qty:
Feed times:
Further instructions:
Exercise/Walk Times:
PET'S HEALTH
Veterinarian:
Clinic/Hospital:
Street Address:
Unit/Building Name:
City:
State:
Zip:
Phone Number:
Allergies:
General
Health/Conditions:
Current Medications
(Frequency and time
administered):
Last Physical Exam:
Last Fecal Exam (For
Internal Parasites):
VACCINATIONS
Rabies - Admin Date:
Rabies - Due Date:
DHLP - Admin Date:
DHLP - Due Date:
Bordatella - Admin
Date:
Bordatella - Due Date:
I hereby agree to the
terms and conditions:
I hereby confirm I am the
Owner/Authorized Agent:
Owner (PRINT NAME):
Electronic Signature
(INITIAL):
Date Signed:
TERMS AND CONDITIONS:

I certify that I am the owner of the agent of the owner of the aforementioned pet, and
that I am authorized to board/groom/daycare the pet and sign this form. I authorize ECO
DOG NYC to contact my veterinarian to confirm health, temperament and vaccinations. I
give consent to ECO DOG NYC to act on my behalf by obtaining veterinary care at my
expense, should ECO DOG NYC deem it necessary. I have read the schedule of fees and
agree to pay all charges at checkout, unless previously arranged. I authorize ECO DOG
NYC to charge my credit card account, if so provided, for any outstanding invoices. I
release ECO DOG NYC (and its agents and employees) from any liability or claim due to
sickness, injury or death of my pet, unless ECO DOG NYC has been negligent in the care
of my pet. I understand that under no circumstances will ECO DOG NYC be liable for
consequential damages or damages beyond the replacement value of my dog.
EMPLOYMENT OPPORTUNITIES!



We have employment opportunities for Dog
Handlers, Walkers and Receptionist. Prior dog handling
experience a must.
You may apply in
person or email a resume to:
ecodognyc@yahoo.com.


Thank you for your interest.
______________________________________________________
For a copy of our complete Membership Application, please click here:
MEMBERSHIP APPLICATION PDF
The owners of Eco Dog NYC welcome you to the our
web site. We hope your visit here is a fun one. Please
contact us directly at the store if you have any
questions. (718) 218-9326
Thank you for stopping by!