Chico Animal Hospital - Boarding Release Form

1

Boarding Release Form

Name of pet(s) that will be boarding at Chico Animal Hospital.

The date your pet will be going home.

List of items brought with pet(s) today and any special directions.

Number where you can be reached or someone else in case of an emergency.

2

If your pet becomes sick or injured while boarding would you like Chico Animal Hospital to treat your pet.

Yes

No

3

Would you like Chico Animal Hospital to treat your pet for fleas before going home? (This pertains to the dogs mostly because they go out in our grass court yard to go to the bathroom.) There will be a $9.95 charge for the product plus a $4.25 medication administering fee.

Yes

No

4

I understand that Chico Animal Hospital is not responsible for any damage or lost items.

5

Signature of pet owner or agent * This field is required.

Clear

6

Digital Signature* This field is required.

Please type your signature

7

Date * This field is required.

Date

8

Email* This field is required.

example@example.com