I am aware if    Patient Name *    is not current that they will be given vaccines at my expense. 

Dog Vaccines that are required to board are Rabies, DA2PPV, Bordetella and Intestinal Parasite Exam. 

Cat vaccines that are required to board are Rabies and FVRCP. 

Exams must be current otherwise a physical exam will be performed while pet is boarding at owners expense. 

Please note any symptoms or problems that you have noticed about    Patient Name *  that you would like to have addressed by a veterinarian during your boarding stay. 

I authorize an exam fee of $45 to have    Patient Name *    examined:    Please Explain

I want    Patient Name *    fed the special diet I provided. Please Select YesNo *    

Please give    Patient Name *    a regular bath (at cost of $35) before being picked up.
Please Select YesNo *    

Regular baths are Free on stays of 5 nights or more

Please list all personal items left with    Patient Name *    and any special needs that we can help with while you are away: Please Specify

Reasonable care will be used against injury, escape, or death of    Patient Name *    AMC staff will not be held responsible for problems that may occur given that reasonable care and precautions are followed. I understand that any problem that occurs with    Patient Name *    will be treated as deemed necessary by the veterinarians at AMC and I assume full responsibility for the treatment and associated expenses incurred. If a situation should arise that   Patient Name *     needs medical care and I cannot be reached, I hereby authorize the veterinarian to examine, prescribe for, or treat     Patient Name *      . I assume responsibility for all charges incurred in the care of this Patient Name *

I authorize    Person Name *    to pick up    Patient Name *    and settle the charges in my absence.