Boarding Admission Agreement- LRVC

Boarding Agreement
This form does NOT act as a boarding reservation, this form allows our team to have the required information before your pets stay!

*FOR MULTIPLE PETS - WE REQUIRE AN AGREEMENT FORM PER PET*
Are you a current client at Lowell Road Veterinary Center?*

YESNO
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number - please list best number to reach you at*

Area CodePhone Number
Phone Number - list any additional number we can reach you at

Area CodePhone Number
Email*
example@example.com
What is the best way to reach you while your pet is staying with us?*

PhoneText (if you provided a cell phone number only)EmailI will not be reachable, please use my emergency contact
Emergency Contact - must be able to make medical decisions if you are not reachable*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact Email
example@example.com
Pet's Name*
ONLY ONE PET PER AGREEMENT FORM
Is your pet current on vaccinations? Canine: Rabies, Distemper, Kennel Cough, HW Test Feline: Rabies, Distemper*

YesNo
Current Heartworm Prevention product (required for boarding): blanks* .
Last date given: blank*.
Current Flea & Tick Prevention product (required for boarding): blanks* .
Last date given: blank* .
Has your pet had a negative fecal exam in the past 6 months?*

YesNo
Please fill out feeding information below

Please provide all dry food in indiviudal ziploc bags labeled with your pets name, the date food is provided for, and AM, MIDDAY or PM as required for the entirety that your is staying with us. Please label all canned food with your pets name, frequency and amount to feed on the front of the can.

If you forget your pets food, we can provide you with a small bag of prescription bland house diet for an additional charge of the cost of the diet (usually $35-50 per 6-8pound bag).

Note: We are unable to take in large bags of pet food - thank you for your cooperation!
Diet-Name of food:*
How many times/day?*
How much at each feeding?*
Please list any additional information we should know about feeding your pet
If none, please type n/a;
Medication & Instructions
If none, please type n/a;
I understand all medications must be brought in their original labeled bottles and/or packaging. (initial) .
Drop off Date*

MonthDayYear
Date
Drop Off Time (MUST be between 3pm-5pm) *

:HourMinutesAM/PM Option
Pick-up Date*

MonthDayYear
Date
Pick-up Time (MUST be between 8am-10am to avoid another day charge)*

:HourMinutesAM/PM Option
If your pet requires basic medical attention while in our care (example: anxiety, ear infection, hot spot, skin abrasions, upset stomach causing vomiting and/or diarrhea, etc.)- do you authorize treatment? NOTE: If we do not hear back from you within 4 hours we will proceed as recommended by the Veterinarian on duty. We will always contact you as soon as possible for any urgent or emergency medical situations.

Yes, please provide basic medical treatment for my pet. I understand I am responsible for the cost. (Not to exceed $150 without your authorization)No, please contact me at the listed method above before providing treatment to my pet. I understand if no contact is made, treatment will be determined by the Veterinarian on duty.
I understand if my pet is not picked up by 10am or is dropped off before 3pm, an additional day of boarding may be charged. (initial) *
I understand if my pet displays unpredictable and/or aggressive behavior towards any Animal Care Coordinators, I am required to make arrangements for my pet to be picked up immediately. (initial)*
By signing your name, you agree to the terms below:
- Reasonable precaution will be used against injury, escape, or death of said animal.
- I understand that any additional items such as bowls, toys or bedding should be left at home unless approved ahead of time.
- I understand that if my pet is due for any required vaccines or prevention while during their stay, or found to be overdue for required vaccines, I will be responsible for the cost.
- I understand that any medical problem that develops with my pet and I am not reachable within 4 hours, my pet will be treated as deemed best by the veterinarians on duty and I assume full responsibility for the treatment expense involved.
- The clinic and staff will not be held liable for problems that develop provided reasonable care and precautions are followed.
- I have confirmed that all my contact information listed above is accurate.
- I understand that my pet is to be dropped off and picked up during the listed hours only or an additional fee may apply.
- I understand that no one is here overnight to supervise my pets.
- I am at least 18 years of age.
Signature*

Clear
Please print full name: blanks* Date: blank*
Should be Empty:

Boarding Agreement

This form does NOT act as a boarding reservation, this form allows our team to have the required information before your pets stay!