Feline Boarding Check In/Consent

FELINE BOARDING CHECK IN / CONSENT
What is your pets name? *
What is your pets species? *
Breed: *
Color: *
Age: *
What is your pets gender? *
About how much does your pet weigh?
What is the owner's first and last name? *
Address: *
City: *
State: *
Zip Code: *
Phone: *
Email Address:
example@example.com
Where is your pet staying? *

Regular Condo Deluxe Condo ICU
While my pet is boarding I would like them to my other pet(s) who are named blank . (Separate names with a comma)
Drop Off Date: *

Month Day Year
Date
Pick Up Date & Time: *

Month Day Year
Date Hour Minutes AM/PM Option
What would you like us to feed your pet? *

Science Diet Adult Own food
How much do you want us to feed your pet? *
How often should we feed your pet? *
When would you like us to begin feeding your pet? *
Would you like any additional treatments?

Bath, Brush Nail Trim Anal Gland Expression Nail Trim Veterinary Exam
Health Concerns you have for the veterinary exam?
Would you like any additional play times at $10/playtime? Please specify dates.
Has your pet had any coughing, sneezing, vomiting or diarrhea? (select all that apply) *

Coughing Sneezing Vomiting Diarrhea None of the above
If yes, please explain:
If you listed yes to any of the above questions please explain.
Is your pet currently on any medications? *
Name/Dose/Last Given:
Please initial below acknowledging you are aware of a $4.25 fee for any medication administration *
Do you need any refills of medications/preventatives/food? *
Name of medication and quantity of refill
IF YOUR PET IS COUGHING, HAS DIARRHEA, OR FLEAS WHILE HERE, AN EXAM AND/OR TEST(S) WILL BE PERFORMED. IF YOU PET IS FOUND CONTAGIOUS, TREATMENT IS REQUIRED FOR THE SAFETY OF THE OTHER ANIMALS BOARDING. ANY TREATMENTS ADMINISTERED DURING YOUR PETS STAY WILL HAVE ASSOCIATED FEES, WHICH I AM RESPONSIBLE FOR.
Please initial acknowledging the statement above. *
IF ANY EMERGENCY/LIFE THREATENING MEDICAL PROBLEMS ARE FOUND WHILE BOARDING (RESUSCITATION), I GRANT PERMISSION FOR DOCTORS TO *
Initial: *
Initial to acknowledge EMERGENCY/LIFE THREATENING SELECTION
Amount pre authorized: *
I understand that if I am unable to be reached the amount listed may be used to treat my pet.
IF ANYTHING NON-EMERGENCY/NON-LIFE THREATENING MEDICAL PROBLEMS ARE FOUND WHILE BOARDING, I GRANT PERMISSION FOR DOCTORS TO: *
Initial: *
Initial for NONEMERGENCY CONSENT
I acknowledge that my property may be damaged or lost during boarding, daycare or hospitalization. I wish, however, to leave the property described below with Waverly Animal Hospital anyway. I accept all risk of loss and damage to property left, I release the business from all liability associated with the loss or damage to my property, and I will not hold Waverly Animal Hospital responsible for loss or damage to my property.
Initial: *
Initial for BELONGINGS CONSENT
Belongings I am leaving with my pet:
To provide a healthy environment and prevent the spread of disease among pets in our facility we require cats to be vaccinated by a veterinarian for Rabies, Rhinovirus, Calicivirus, Panleukopenia, and having a negative fecal sample within the past 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/SENT IN PRIOR TO OR AT CHECK-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.
Signature

Clear
Date *

Month Day Year
Date
Please verify that you are human *
Should be Empty:

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FELINE BOARDING CHECK IN / CONSENT