Boarding Registration

Owners Name *

First Name Last Name

Pet’s Name *

Primary Phone *

Please enter a valid phone number.

Secondary Phone

Please enter a valid phone number.

Authorized Person(s) to pick up your pet or take off hospital grounds: *

Will you bring your own food? *

Yes No

Brand of Food *

Can we add chicken, canned food, pumpkin to your pet’s food if needed? *

Yes No

Feeding Instructions *

Select one of the following: *

I brought my own measuring cup Use Bay Animal Hospital's measuring cup (see staff member for example)

Last time your pet ate *

Hour Minutes

AM/PM Option

Does your pet require medications during their stay? *

Yes No

Please List All Medications Below: *

Name of Medication and Dosage (MG, ML), How many tablets or milliliters?, Times per day?, Last time RX was given?

Does your pet have any special needs or any new concerns? *

Yes No

If yes, please specify *

Additional Services During Stay (additional charges apply):

Exam Bath Medication Refill(s) Vaccines

Please list the medications you need refilled below: *

Has your pet ever had a vaccine reaction? *

Yes No

Pick up Date *

Date

Pick-up Time *

Hour Minutes

AM/PM Option

Emergency Contact *

First Name Last Name

Emergency Contact Phone Number *

Please enter a valid phone number.

In the event of a pet medical emergency and you or your representative are unavailable: *

Do whatever is medically necessary for the health and well-being of my pet; I accept financial responsibility. Render only what you deem minimally necessary for the life of my pet; I accept financial responsibility.

Pets will be available for pick up any time during our normal office hours and no later than 30 minutes before closing.

If your pet is scheduled for a bath before they go home, a Client Care Specialist will call you when your pet is ready for pick up.

*

I understand the nature of boarding services provided by Bay Animal Hospital (BAH) and the costs associated with the services I have requested. I further confirm that all the information I have provided above are correct to my knowledge and signing this form grants authorization for BAH to fulfill the needs specified on this form.

*

I also understand that BAH does not recommend any personal items to be kept in the boarding enclosure with the pet as they may get damaged or lost. BAH does not assume responsibility for these items (this includes beds, blankets, toys, collars/leashes, clothes, chews or toys.

*

I understand that rawhide chews and pet toys may present choking hazards for pets and therefore BAH does not allow these items to be left with pet unattended. Continuous presence of BAH personnel is not routinely provided during non-business hours, but fresh water, food and freshly laundered blankets and towels are provided every day when safe to do so. Cat litter is scooped twice daily and dogs are walked at least 3-4 times daily or as needed.

Date *

Date

Signature *

Clear