Zoomies Cafe LLC

DOGGY DAY OUT PROGRAM

LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT

READ CAREFULLY AND COMPLETE ALL SECTIONS BEFORE SIGNING

A. Registration of Participant and Agreement Purpose: I, the following listed individual, do hereby voluntarily agree to participate in the Doggy Day Out program provided by Zoomies Cafe LLC (“Zoomies Cafe”).

First name

Last name

Birthday

Month

Day

Year

Does Participant have any physical or mental condition(s) that may affect his/her safety and ability to interact with a dog? If Yes please describe how we can accommodate this Participant's special needs:

Medical Insurance:

Participant agrees that: Should medical treatment be required, the Participant’s medical insurance shall pay for ALL such incurred expenses.

Medical insurance company is:

Policy number is:

Participant does not carry medical insurance.

Medical Insurance Card

Medical Insurance:

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