Lake Seminole - Boarding Pet Care And Hurricane Agreement Form

1
Client Name* This field is required.
First Name
Last Name
2
Phone Number* This field is required.
3
Email* This field is required.
example@example.com
4
Arrival Date* This field is required.
Date
Year
Month
Day
5
Patient Information* This field is required.
Pet's Name
6
Boarding Pet Care Agreement

To make your pets stay as pleasurable and safe as possible, I agree with and consent to the following information:

All boarding dogs must be:

currently vaccinated for DHPP ("distemper/parvo"), Rabies·

vaccinated for Leptospirosis, Influenza H3N2/H3N8 and Bordetella within the last year·

blood tested for heartworm disease within the last year and presently be on monthly heartworm prevention·

stool sample microscopically tested and no intestinal parasite eggs found·

be flea free; if fleas are found on admission, pet will be treated at cost to owner

All cats must be

currently vaccinated for FVRCP

vaccinated for Bordetella and Rabies within the last year

be flea free; if fleas are found on admission, pet will be treated at cost to owner

For your information:

Our hospital is closed on Sundays; no pick ups or admissions. Staff members provide scheduled care inshifts during the weekend or holidays when the office is closed.We are not a Hurricane Season Shelter; please plan ahead for evacuation of your pet.I have read the Boarding Pet Care Agreement and give lake Seminole Animal Hospital permission to treat my pet should illness or injury occur. Every effort will be made to reach you; if unable to reach you treatment will be administered and the cost of treatment will be my responsibility. I acknowledge the boarding rates to be charged by night. My pet meets the boarding requirements for vaccination as indicated in my pet's record presented to, or maintained by staff. I understand that current information will need to be provided to the staff for every visit of boarding services.
7
Hurricane Season Evacuation Information

To the best of our ability, we will provide care for your pet as well as to our staff who may voluntarily evacuate if advised by authorities. Our location is Zone B and may not provide adequate protection for your pet in the event of a disaster. When the County issues Mandatory Evacuations for Zone B, we willcomply and evacuate our facility.

Therefore, it is required with every boarding event during the season, you, the pet owner or agent, provide us with the name and phone number of the person who is responsible for picking up your pet from our facility in the event of mandatory evacuation if you cannot return to do so within 4 hours of first notification.
8
Acknowledgment For Each Event Of Boarding During Hurricane Season
I am the * of the pets on record, and have the authority to sign this acknowledgment. I hereby acknowledge my understanding that Lake Seminole Animal Hospital
recommends and complies with Pinellas County evacuation orders. I understand my obligation and requirement to provide accurate contact information for my emergency contact list. I realize that Lake Seminole Animal Hospital staff may not have the ability to remain on site in the event of evacuation. In the event of injury due to a disaster, I give consent to the veterinarians to medicate, anesthetize, treat and perform any surgical procedure(s), as are in their opinion, necessary and advisable. I accept all procedures to be done to the best of the abilities of the professional staff in such an emergency event, and I realize that no guarantee can ethically or professionally be made. I assume all financial responsibility and agree to hold Lake Seminole Animal Hospital harmless in its efforts to care for my pet(s) if my pet is not evacuated by myself or my emergency contact person named below in the event of a disaster. I understand every reasonable effort will be made to keep my pet safe.
9
Signature* This field is required.
Clear
10
Today's Date* This field is required.
Date
Month
Day
Year
Should be Empty: