Annual Boarding Release Form

Annual Boarding Release Form
Owner's Name*
Phone*
Pet's Name*
Drop Off Date*

MonthDayYear
Date
Pick Up Date*

MonthDayYear
Date
In the case of illness or injury, I the undersigned, do hereby give my authorization and consent for the doctors of Main Street Veterinary Hospital to examine, prescribe for, and treat my pet(s) while they are being boarded. I am 18 years of age or older, and assume responsibility for all charges incurred in the care of my pet. I also understand that professional fees are due at the time services are rendered.*
Please initial that you have read and understand the above paragraph
If any problem is observed or develops:*

Please treat my pet as required, you do not need to call me.Perform only emergency and supportive care. Notify me for permission to begin any other treatment.Do NOT perform any diagnostics and/or treatment until I am notified and consent for you to evaluate and treat as recommended.
Vaccines: All dogs must be current on DHPP(distemper/parvo), Bordetella, Rabies, and a current fecal. All cats be current on FVRCP and Rabies.*
Please initial that you have read and understand the above paragraph
If vaccinations were performed elsewhere. I can provide written documentation of the Rabies vaccination administered by a licensed veterinarian within 24 hours of notification to do so in the event my pet should bite any person or other pet while on the clinic premises.*
Please initial that you have read and understand the above paragraph
Fleas, Ticks, & Intestinal Parasites: I understand ALL pets admitted to the hospital must be protected against communicable contagious diseases and must be free of internal and external parasites or they will be treated on entry or discovery at the owner/agent's expense.*
Please initial that you have read and understand the above paragraph
All pets are fed a GI friendly diet twice daily unless other instructions are provided at the time of drop off. I understand that I am welcome to bring my own pet's food if desired and will be asked to provide the brand name of food along with feeding instructions at the time of admission.*
Please initial that you have read and understand the above paragraph
Personal Belongings: MSVH will provide appropriate bedding for all pets. If you prefer to leave personal belongings with your pet, we ask that you limit them to two items and you will be asked to provide details of all personal belongings at the time of admission. We will make every effort to return items in good condition but this cannot be guaranteed.*
Please initial that you have read and understand the above paragraph
Social Media: I consent for my pet's photo to be used in marketing materials or social media posts (Facebook/Instagram). If you would like to see your pet while they are boarding, be sure to follow us on Instagram....@mainstreetvetlkn_boarding.*
Please initial that you have read and understand the above paragraph. If you wish to decline, indicate "DECLINE"
Pick up Date: I will call if my "pick up date" changes so you can plan accordingly. If I neglect to pick up my pet within 5 days of the dates scheduled for discharge, and do not notify you within that time period, you may assume that the pet is abandoned and are hereby authorized to handle the pet as you deem best and/or necessary.*
Please initial that you have read and understand the above paragraph
By signing below, I give my consent for boarding services provided by Main Street Veterinary Hospital for the year of 20*
Type in last 2 digits of current year (example: for 2021, type 21)
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: