Groves VC - Boarding Registration Form

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Hours: Monday – Friday 7:30am to 7:00pm || Saturday 8:00am to 2:00pm

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General Information

Client’s Name

Pets Name

Entry Date

Entry Time

Expected Date of Return

Return Time

Emergency Contact Name

Emergency Contact Number

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MEDICAL INFORMATION

For the welfare of every guest in our kennel, we require that your dog has a current RABIES, DISTEMPER and KENNEL COUGH/BORDETELLA (within 6 months) vaccination and your cat has a current RABIES and FVRCP vaccination. A negative fecal examination is required within the last six months for all pets. You must provide proof of vaccination and fecal examination if your pet was vaccinated and tested at another location.

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List Dates Administered

Rabies

DA2PP

Bordetella

FVRCP

Negative Fecal

#1

#2

#3

#4

#5

#1

#2

#3

#4

#5

Rabies

DA2PP

Bordetella

FVRCP

Negative Fecal

Rabies

DA2PP

Bordetella

FVRCP

Negative Fecal

Rabies

DA2PP

Bordetella

FVRCP

Negative Fecal

Rabies

DA2PP

Bordetella

FVRCP

Negative Fecal

Rabies

DA2PP

Bordetella

FVRCP

Negative Fecal

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List Current Medications

Medication Name

Strength

Administration Instructions

Time of Last Dose

#1

#2

#3

#4

#5

#1

#2

#3

#4

#5

Medication Name

Strength

Administration Instructions

Time of Last Dose

Medication Name

Strength

Administration Instructions

Time of Last Dose

Medication Name

Strength

Administration Instructions

Time of Last Dose

Medication Name

Strength

Administration Instructions

Time of Last Dose

Medication Name

Strength

Administration Instructions

Time of Last Dose

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List Medical Conditions

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List Allergies

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FLEA AND TICK CONTROL

Our facility is flea and tick free. Flea and tick prevention must be given within the last 30 days. This medication must be purchased from our office to be considered valid. If your pet is overdue for flea and tick prevention, an application will be required prior to admission at your expense. If your pet has fleas or ticks upon admission, medication will be administered at your expense.

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FLEA AND TICK CONTROL

Date Applied

Name of Product Applied

Apply While Boarding

Initial

#1

Date Applied

Name of Product Applied

Apply While Boarding

Initial

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HEARTWORM AND INTESTINAL PARASITE PREVENTION

Our facility is parasite free. Heartworm medication containing intestinal parasite prevention must be given within the last 30 days. This medication must have been purchased from our office to be considered valid. If your pet is overdue, a fecal exam will be required upon admit and treatment of any parasites found will be required at your expense.

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HEARTWORM AND INTESTINAL PARASITE PREVENTION

Date Given

Name of Product

Initial

#1

Date Given

Name of Product

Initial

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FEEDING INSTRUCTIONS - Food must be provided by the owner. If forgotten, we will provide a bag of food at the owner’s expense. The owner assumes all risk associated with changing the pets diet and will pay any fee for treatment or medication needed as a result.

Initial

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Feeding Instructions

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ILLNESS OR INJURY

Groves Veterinary Clinic will use all precautions against illness, injury or escape of pets. However the clinic will not be held liable or responsible in any manner what so ever for my pet as it is thoroughly understood that I assume all risks. In case of illness or injury, I, the undersigned, do hereby give my authorization and consent to the doctors of this hospital to treat, prescribe for, or to operate on my pet at my expense while it is being boarded at Groves Veterinary Clinic. All pets are given a pre boarding exam by a veterinary technician at no additional charge. If you prefer a complete physical examination by a doctor at a fee of $38.00, please let us know.

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Request exam by the doctor at a fee of $38.00

Yes

No

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Initial

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BEDDING, TOYS AND OTHER PERSONAL ITEMS - We provide bedding, bowls and leashes for all our boarders. We will not allow personal items or toys to be left with pets. If left, there is a possibility they will get damaged or lost and we will not be held responsible.

Initial

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BATHING AND GROOMING

Let us know if you would like to take advantage of our dog and cat grooming services while your pet is our guest. If your pet is bathe or groomed, please call ahead to let us know when you will be picking up.

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I would like grooming services during my pets stay

Yes

No

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Initial

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I have read and understood the boarding release form. All of my questions have been answered and I am releasing my pet to the care of Groves Veterinary Clinic. My pet has not shown any recent signs of illness or injury and I have no concerns regarding the health of my pet. I understand there is always a risk of illness or injury while boarding and I accept that risk. I understand I will be charged an additional night of boarding if my pet is not picked up by 11:00am.

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Owner Signature* This field is required.

Clear

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Date* This field is required.

Date

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Best contact phone number

Additional contact phone number

Email