Canine Boarding Travel Sheet

Owner's Name:*

First NameLast Name

Owner's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Owner's Phone Number*

Please enter a valid phone number.

Owner's Email

example@example.com

Dog's Name*

Dog's Breed*

Dog's Color*

Dog's Age*

Please Choose*

Dog's Gender*

Dog's Weight

Please chose:*

Emergency Contact Name:*

Emergency Contact Phone Number*

Please enter a valid phone number.

DROP OFF DATE*

Date

DROP OFF TIME*

Hour Minutes

AM/PM Option

PICK UP DATE*

Date

PICK UP TIME*

Hour Minutes

AM/PM Option

My dog is boarding:*

If your pet is SHARING a reservation, please list who he/she is sharing with:

We require your pets to be fed in the same run for them to board together. If they need to be separate to feed then they will need to be separate for the duration of their stay.

**If your pet is on medications and they are sharing a run with another pet we may need to separate them for their stay (if unsuccessfuly able to give the medications) and the charges will be adjusted accordingly**

FEEDING NOTES:

We do require that all dry food be packaged individually in meal portions. We do not have the storage space for containers or commercial bags of food in our kennel. Please use ziplock bags with your pets name in permanent marker on each bag.

FREE FEEDING IS NO LONGER AN OPTION. You must provide meal amounts for your pet.

If you did not MEAL PACKAGE your own food and are feeding Waverly Animal Hospital Food, how much do you feed your pet?*

How often do you feed your pet?*

When do you want us to begin feeding?*

Special Instructions for FEEDING

What kind of food do we feed?*

Additional Services Requested:

Bath, Brush, Blow Dry, Nail Trim ($ varies by breed)Nail Trim ($25.00)Anal Gland Expression ($27.00)Professional Groom (hair cut, $ varies by breed)

If you would like a Professional Groom during the boarding, please list in detail the instructions for the hair cut:

Playtimes: Please list the dates you would like to add on playtimes ($15.00 each playtime) (if your pet is scheduled to board in either Deluxe Runs, Deluxe Condos, or Ultimate Deluxe Condos playtimes are INCLUDED, please do not indicate you would like playtimes unless they are additional on top of the ones that come with their kennel accommodation)

Late Walks: Please list the nights you would like to add-on a late walk: ($9.00 each night)

Would you like to add on any engagement toys for you dogs stay?

If you answered yes the the questions above, please list what dates you would like to add-on engagement toys.

Please list each Deluxe Daycare 1/2 Days Add-on dates (only available M-F): ($27.00 each day)

Please list each Deluxe Daycare Full Days Add-on dates (only available M-F): ($48.00 each day)

In the past 14 days, has your pet had any problems? Please check all that apply.*

In the past 14 days, has your pet visited? Please check all that apply.*

Another Boarding FacilityAnother Daycare FacilityA dog parkNone

If yes, explain:

Is your pet on medications that need to be administered here?*

If yes, Name/Dose Last Given: YOU MUST ALSO COMPLETE THE MEDICATION ADMINISTRATION FORM ON OUR WEBSITE FOR DETAILED INSTRUCTIONS.

Do you need Refills of any medications? Please include quantity requested.

Our scheduled times for medication administration are: 7am, 12pm, 4pm, 7pm and 11pm. Each time a technician has to administer medications there will be a $9.00 charge (regardless of the quantity of medications given at that time).

IF ANYTHING NONEMERGENCY (NONLIFE THREATENING) MEDICAL PROBLEMS ARISE WHILE BOARDING, I GRANT PERMISSION FOR DOCTORS TO*

IF ANYTHING EMERGENCY (LIFE THREATENING) MEDICAL PROBLEMS ARISE WHILE BOARDING, I GRANT PERMISSION FOR DOCTORS TO:*

In the event that your pet needs life saving treatment, please provide a dollar amount that you authorize (if we are unable to reach you).*

Belongings (Please be as detailed as possible)

Boarding Check-in & Check-out Hours:

Monday - Friday 7am-7pm

Saturday 8am-4pm

Sunday 4pm-6pm (Boarding ONLY)

Please initial below that your drop off and pick up times are between these hours*

MEDICAL RELEASE FORM

First and foremost, the safety and well-being of your pet(s) is of the highest importance. Insuring that your pet remains safe and well cared for is our first responsibility and as such we take it very seriously. We do our best to have our pet parents screen for pre-existing health conditions but some factors may be beyond our control. In the event that a medical emergency arises while a pet is at our facility it is imperative that we are immediately able to get them medical treatment.

I understand that in the event of a medical emergency that Waverly Animal Hospital, at its sole discretion, deems to need the immediate attention of a licensed veterinarian, I authorize Waverly Animal Hsopital provide medical attention. I further agree that I am financially responsible for any medical treatment my pet(s) receives as a result of a medical emergency while boarding.

DISCLOSURES:

1. IF MY PET IS COUGHING OR SNEEZING, HAS DIARRHEA OR VOMITING, FLEAS, OR ANYTHING POTENTIALLY CONTAGIOUS, AN EXAM AND/OR TEST(S) WILL BE PERFORMED. IF MY PET IS FOUND CONTAGIOUS, TREATMENT IS REQUIRED FOR THE SAFETY OF THE OTHER ANIMALS AND STAFF. I AM AWARE THAT I AM RESPONSIBLE FOR ANY FEES ASSOCIATED WITH DIAGNOSING AND TREATING MY PET.

2. SHOULD MY PET CONTRACT INFECTIOUS TRACHEOBRONCHITIS DURING OR AFTER THEIR STAY, WAVERLY ANIMAL HOSPITAL, BOARDING & GROOMING WILL NOT BE HELD RESPONSIBLE AS THIS AN INHERENT RISK OF ANY KENNEL ENVIRONMENT.

3. I UNDERSTAND IF I SELECT "CALL FIRST", AND I CAN NOT BE REACHED, MY PET WILL BE TREATED AND I AM RESPONSIBLE FOR ANY FEES ASSOCIATED WITH DIAGNOSING AND TREATING MY PET.

4. 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.

5. I UNDERSTAND I WILL BE PROVIDED WITH AN ESTIMATE FOR MY PETS STAY, AND THAT IF MEDICAL CARE IS ADDED, THE STAFF WILL PROVIDE AN ADDITIONAL ESTIMATE OVER THE PHONE. I ALSO UNDERSTAND THAT THE ESTIMATES MAY NOT BE EXACT AND SERVICES/MEDICATIONS ARE SUBJECT TO CHANGE.

6. I release WAVERLY ANIMAL HOSPITAL, its staff, owners and any representatives from any and all liability which I or my dog(s) may suffer including but not limited to injury, sickness, damage, or death resulting from participation in boarding.

In the event my pet is experiencing stress induced diarrhea we can administer a probiotic without consulting a doctor. Would you like your pet to be treated with a probiotic?

Please initial to acknowledge that you read the above medical release form and disclaimers.*

I have the completed the form and all information provided is accurate as of the drop off date, despite the date I may be completing the form. If any changes need to be made at check-in, it is my responsibility to mention in to check in staff.

Signature*

The category of boarding I RESERVED ALREADY is:*

CANINE BOARDING TRAVEL SHEET