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CRCG
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CRCG Client Intake & Liability Form

CRCG Client Intake and Liability Form

We require all our new clients to complete and sign this intake form prior to the first appointment. Sending us this information prior to your appointment will allow more time dedicated to the exam, treatment planning, and answering any of your questions.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Which CRCG location are you visiting?*

Client Information

Name*
Address
MM slash DD slash YYYY
Other Guardian Name

Pet Information

Pet Name*
MM slash DD slash YYYY
MM slash DD slash YYYY
Sex*
Spay/Neuter*

Current Health Information

Does your dog have any condition that we should be aware of such as recent surgery, injuries, treatment, been sick lately or have a need for daily medication?*
Has your dog harmed any person or shown aggressive behavior towards any person or any other dog?*
Consent*
Swim & Play Rules can be found at http://dog-swim.com/wp-content/uploads/2020/11/CRCG_SwimPlayRules.pdf
How did you hear about us?*
Do we have your permission to add you to our CRCG newsletter mailing list?*
ie: Monthly specials, Holiday theme parties, fundraisers, contests, game days, etc. (Note: CRCG does not share or sell your contact information. All information is confidential.)
How would you like to be contacted with appointment reminders?*

Additional Pets

Pet Name
MM slash DD slash YYYY
Sex
Spay/Neuter
MM slash DD slash YYYY
What brings you to CRCG?*
My dog is healthy and not under treatment at this time.*

Liability Agreement

Please select the checkboxes to indicate you have read and understood the information provided.
I have reviewed and selected the above conditions of the liability agreement. CRCG will be unable to treat my pet if the liability agreement is not completed prior to my first appointment.*

Photo Release

I grant to CRCG, its representatives and employees the right to take photographs of me and my dog in connection with any CRCG services. I authorize CRCG, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that CRCG may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.*

CRCG Recreational Pool Policy

I agree that there are inherent risks to me associated with use of the CRCG facilities arising out of or associated with use and conditions, such as swimming, wet floors, exercise mats, and other dogs. In consideration for CRCG granting me permission to use these facilities, I agree to release CRCG from liability arising out of or associated with such use, and hereafter waive any and all claims which may arise out of or be associated with such permissive use of the CRCG facilities.*
I certify that I have read and understand this Agreement and that the information set forth above is true and correct. I agree to accept all the terms, conditions, and statements of this agreement, and any rules or regulations of CRCG.
info@dog-swim.com 303-762-7946
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Broomfield

8855 W. 116th Circle
Broomfield, CO 80021

Englewood

3760 S. Lipan St.
Englewood, CO 80110

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