CANINE BOARDING AGREEMENT

Agent/Owners Name: *

Dog's Name: *

Email Address: *

example@example.com

Primary Phone: *

Make sure to include area code!

Emergency Contact (other than owner) Name and Phone *

Make sure to include area code!

Primary Veterinarian Name and Phone

If other than Waverly Animal Hospital

Permission to obtain veterinary medical records if necessary:

YES No

To provide a healthy environment and prevent the spread of disease among pets in our facility we require dogs to be vaccinated by a veterinarian for the following: Rabies, Bordetella (within 6 months), Distemper/Adenovirus (hepatitis)/Parvovirus/Parainfluenza combination (often listed as DHPP or DA2PP), and Leptospirosis (within 12 months), as well as proof of a negative intestinal parasite screen (IPS) in the last 12 months . It is highly recommended that all vaccinations be up to date at least 7 days prior to boarding. IF YOUR PET IS DUE DURING ITS STAY FOR ANY OF THE ABOVE WELLNESS SERVICES, AND RECORDS WERE NOT BROUGHT IN TO SHOW PROOF OF BEING DONE ELSEWHERE, YOUR PET WILL BE VACCINATED/TESTED IN ACCORDINANCE WITH OUR POLICY, AND ADDITIONAL CHARGES WILL APPLY AT PICKUP.

Rabies Date Given:

Date

DHPP Date Given:

Date

Leptospirosis Date Given:

(Date must be within the past 12 months)

Bordetella Date Given:

(Date must be within the past 6 months)

IPS/Fecal Date Performed:

(Date must be within the past 12 months)

- Testing and treatment is required for potentially contagious diseases or parasites (coughing, diarrhea, vomiting, fleas, etc) at the owners expense. Initial: *

Clear

- Should the owner’s dog contract infectious tracheobronchitis during, or after their stay, Waverly Animal Hospital, Boarding & Grooming will not be held responsible as this is an inherent risk of any kennel environment. Infectious tracheobronchitis (also known as Bordetella or “kennel cough”) is a highly contagious airborne disease of dogs. It is similar to whooping cough in humans and generally runs its course in 10-14 days; some cases can be more severe and have a prolonged recovery. The disease is caused by a combination of viruses and bacteria. A combination vaccine is available for prevention. Dogs showing symptoms of the disease, or recently recovered, will not be allowed to board until they are asymptomatic for 2 weeks. Owner understands that even vaccinated dogs can sometimes contract infectious tracheobronchitis, although usually the symptoms are less severe than in an unvaccinated dog. Initial: *

Clear

- For any pet boarding more than 7 days, prepayment for the total boarding amount is required at the time of drop off. Initial: *

Clear

- Any pet who has never boarded with Waverly Animal Hospital in the past three years, is required to prepay the total boarding amount at the time of drop off. Initial: *

Clear

Is your pet on any medications? *

Yes No

List medications:

NOTE: You will also need to submit a BOARDING MEDICATION form.

Has your dog every had a seizure? *

Yes No

If yes, date of last seizure:

Date

Please list any medical conditions or health concerns we should be made aware of:

Has your dog ever growled at another dog? *

Yes No

If yes, please explain:

(For growling at another dog)

Has your dog ever growled at a person? *

Yes No

If yes, please explain:

(For growling at a person)

Has your dog ever bitten, or attacked, another animal? *

Yes No

If yes, please explain:

(For biting/attacking another animal)

Has your dog ever bitten, or attacked, a person? *

Yes No

If yes, please explain:

(For biting/attacking a person)

Has your dog ever jumped over, or dug under, a fence? *

Yes No

If yes, please explain:

(For fence jumping or digging)

Is your dog afraid of anything? *

Yes No

If yes, please explain:

(For being afraid of things)

Has your dog ever shown possessiveness, or aggression, over any of the following: (Check all that apply) *

Toys Food/Treats People Other pets Crate/Kennel/House None of the Above

If yes, please explain:

(For possessiveness/aggression)

Please list any other pertinent information on your pets habits/behavior:

Does your dog have food allergies? *

Yes No

If yes, please explain:

(Food allergies)

Does your dog have a sensitive stomach? *

Yes No

If yes, please explain:

(Sensitive Stomach)

Did you bring your own food? If yes, we request that your PRE-PACKAGE individual meals for your pet. *

Yes No

What brand & FLAVOR do you feed your dog? *

How much do you feed your dog? *

Please use a standard 8oz cup

How often do you feed your dog? *

Please check the appropriate food you would like us to feed your dog, if we happen to run out of your food or if you did not bring your own food. *

Science Diet Sensitive Stomach/Skin Chix/Barley Iams Mini Chucks Iams Lamb & Rice Iams Puppy Chix/Corn

Owner is responsible for paying for any prescription diet that is opened for their pet. (Waverly Animal Hospital will use best judgement in adjusting diets for pets refusing to eat or losing weight). Initial: *

Clear

1. Boarding is charged by the night, there is a discount applied for multiple nights of boarding and a "miminum fee" for a single overnight stay. We request that you check-in/drop off your pets after 1pm and check-out/pick up your pets prior to 1pm (except on Sundays).

2. Pets must be dropped off and picked up during regular hours of business. Please contact the office if you are unsure of hours on a specific date.

3. Personal items are left at the owners risk. We are not responsible for loss or damage.

4. There is an additional fee for medication administration. I am aware that I can not place medications/supplements into my pets food bag to prevent this fee.

5. Morning, noon, and evening walks are included for all boarding areas; a twenty minute one-on-one playtime is included for pets staying in the "Deluxe" categories. If a pet is staying in "Deluxe" and elects to receive deluxe daycare, they will not recieve their playtime that day.

6. Waverly Animal Hospital reserves the right to refuse any dog at check in.

7. Owner agrees to pick up their pet on their scheduled day or to notify Waverly Animal Hospital if reservations need to be extended, prior to the pick up date/time. The pet will be considered abandoned if the owner fails to pickup the pet within 10 days of receiving the abandonment letter. Waverly Animal Hospital will handle pets in accordance with Michigan State law. Abandoning pets does not relieve the owner of the financial obligation to Waverly Animal Hospital.

8. Owner agrees to make complete payment to Waverly Animal Hospital, Boarding, & Grooming at the time of check-out.

9. Waverly Animal Hospital reserves the right to request payment and deposits at their discretion.

10. Boarding Agreement remains valid for 1 (one) year from this date.

I certify that this is completed to the best of my knowledge and all the information is true and accurate. I have read, understand, and agree to all provisions. Owners Signature: *

Clear

CANINE BOARDING AGREEMENT

Vaccination and Intestinal Parasite Screen Policy

PLEASE INITIAL THE FOLLOWING 4 STATEMENTS:

Health and Behavior

Feeding Information

Boarding Disclaimers and Provisions