Southern Charm Mini Aussies/Mini American Shepherds of Georgia
Karla, Mike, and Kirsten Benjamin
Karla 770-241-1485 Mike 770-633-3555
Voice mail isn't working. Please try calling back or you may also text the first number.
9am to 9pm Daily for phone calls.
Client Information Record
Owner’s Name: _____________________Email: ___________________________
Address: _________________________ City / State / Zip:_____________________
Cell Phone #1: _______________ Cell Phone#2:_____________Work:____________
Pet Type: ______________ Spayed or Neutered? ____________
Pet’s Name: ________________ Breed(s): ________________________________
Sex: ______ Weight: ________ Color: ____________Birth-date: ________________
Medical Information – Veterinarian’s Name / Clinic: ___________________________
Phone: ________________City / State / Zip: ______________________________
No Shots, No Docs, No Service! SCMA will not board, train, provide daycare, or groom your pet without updated vaccination documentation. So, please provide vaccination documentation and medical records.
Last NuVet wafer was given? _________________ Pets will not be boarded without daily NuVet supplements being given. This protects your dog as well as the other dogs here being boarded and Kennel’s own personal dogs.
In addition, please list the current expiration dates for the following vaccinations:
Rabies ______________ DHLPP _______________ Bordetella _______________
Last flea/Tick Preventative: Type and Date ________________________________
Please describe any medical or physical conditions, including any medications or allergies. __________________________________________________________________________________
Emergency Contact (other than owner) Name: _________________________________________
Phone: __________________ Email: ___________________________
Type of Food ____________________How Much________ How Often_________
Brand and Formula
Is your dog housebroken? __________
Does your dog know basic commands? _______ Will you dog come when called? _______
Is your dog a destructive chewer? ___________ Is your dog crate trained? ________
Food Allergies? ________ If so, what food and what is the reaction?________________
Does your dog have a fear of thunderstorms or Fireworks? _____ If yes, what is used to treat?
Has your dog ever attended daycare or been boarded in a crate-free environment? ________
Can your dog jump over a 4-foot fence or possibly dig underneath it? _________________
Has your dog been exposed to cats? _____ Their reaction? _______________________
Has your dog been ill in the last 30 days? ___________
Is your dog displaying any unusual symptoms such as coughing, sneezing, or upset stomach?
Has your dog ever bitten, attacked or shown aggressive behavior towards people or dogs?
_________ If yes, explain: ____________________________________________
Has your dog ever been bitten or attacked by another dog, or been abused? __________ If
yes, explain: _______________________________________________________
Please describe any behavioral problems, identify any dietary conditions, or other important information we should know:
SCMA Representative Pet Owner
Signature Date Signature
Please let Southern Charm Mini Aussies know if any of this information given changes so that a new information sheet can be filled out.
This is a Contract between Southern Charm Mini Aussies (hereinafter called "Kennel") and the pet owner whose signature appears below (hereinafter called "Owner") for services for (hereinafter called "Pet").
Payment is expected for services at the time of pickup. Cash, personal checks or Facebook pay are the only forms of payment accepted for services. Owner agrees to pay the rate for boarding which is now $ _______ which is in effect on the date Pet is checked into the Kennel as posted on the Kennel's website. A discount is given for multiple pets being boarded at the same time by the same owner. Pets picked up after 12:00 noon will be charged the full boarding rate for that day. No pick-ups or drop offs before 8am or after 9pm. Owner agrees to bring food, Nuvet, treats, and blanket for crate. Kennel is happy to accept any items from home that you feel would benefit your dog during their stay with us. We simply ask that you make sure the items are clean. Be advised however, that we can make no assurance that you will get your items back either in the shape you brought them or at all. We do our best to launder/clean items should they become dirty but can make no guarantees to that effect. We do provide water and food bowls, so you may leave those items at home. Please take leashes with you when you drop off your dog. They will not be needed during the stay. Owner agrees to pay all costs and charges for special services requested, plus all veterinary expenses deemed appropriate by Kennel for Pet during the time it is in the Kennel's care. Kennel shall attempt to contact Owner before incurring such veterinary services as may be required by Pet's health and/or behavior.
Due to the social nature of our Kennel, there are some inherent risks. These risks may include but are not limited to: transfer of communicable diseases such as Canine Kennel Cough or some types of bacteria or viruses. Injuries may include, but are not limited to: broken nails, sore feet, puncture wounds, abrasions and cuts. These injuries are generally benign and can usually be managed by us or at home. In some cases, veterinary care may be required.
Kennel shall exercise reasonable care for Pet delivered by Owner to Kennel for boarding. It is expressly agreed by Owner and Kennel that Kennel's liability shall in no event exceed fair market value for the Pet boarded. The Owner further agrees to be solely responsible for any and all acts or behavior of said Pet while it is in the care of the Kennel. Owner agrees to be financially responsible for kennel property damaged by Pet. Reasonable costs for damage will be payable upon checkout of Pet.
Owner specifically represents to Kennel that Pet has not been exposed to rabies or distemper within a thirty-day period prior to boarding. Kennel requires proof of current Rabies, Distemper and Bordetella vaccinations. We recommend a Bordetella vaccination every six (6) months. The Bordetella vaccine is not 100% effective. It is recommended that it be given to your dog at least two (2) weeks prior to Pet's arrival date to increase efficacy. Kennel makes no guarantees regarding the Bordetella vaccine. All pets are checked for external parasites (fleas/ticks) upon entry to the facility. If any external parasites are found, they will be treated accordingly, and Owner will be responsible for those expenses.
If Pet becomes ill or if Pet's behavior is endangering itself, humans, or other animals, Kennel, in its sole discretion, may engage the services of a veterinarian. All attempts will be made to contact the Owner of the Pet first; however, in the event of an extreme emergency, the well-being of the Pet comes first. Medication will be administered as necessary under the direction of a veterinarian. The undersigned Owner hereby gives the veterinarian complete authority to treat Pet in whatever manner deemed necessary. Owner will be responsible for all veterinary charges upon release of the Pet. Owner also gives full authority for the treating veterinarian and their associates to discuss with Kennel any aspect of any illness or injury that the Kennel has presented for treatment.
Owner authorizes Kennel to use pictures of their Pet taken while participating in Kennel activities on Facebook and/or SCMA parents page.
If a dog’s stay exceeds 4 days after the scheduled pick up date without direct contact from the owner, then pursuant to Georgia law, the dog becomes the property of Southern Charm Mini Aussies. This scenario also includes bills that have not been paid or cannot be paid. Yes, this has happened before!
By signing this Agreement and leaving Pet with the Kennel, Owner certifies to the accuracy of all information given about Pet to the best of their knowledge. Owner specifically represents that he or she is the sole owner of Pet.
By signing this Agreement, Owner indicates that he or she has read and accepted all policies listed in this agreement as well as all policies on Kennel's Schedule of Services and Fees.
This agreement shall be governed by and construed in accordance with the laws of the State of Georgia. Each party consents to the exclusive personal jurisdiction of the state and federal courts of the State of Georgia. Owner and Southern Charm Mini Aussies must negotiate and mediate in good faith prior to either party filing a case of action.
This contract contains the entire agreement between the parties. This contract will stay in effect until a written statement is received to cancel boarding or a new agreement is in effect.
SCMA Representative Pet Owner
Signature Date Signature