Feline Travel Sheet

Pets Name*

Pets Age*

Pets Gender*

Pets Breed*

Pets Color*

Weight

Owners Name

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Owners Email

example@example.com

Phone Number*

Please enter a valid phone number.

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

The boarding I already reserved for my pet is*

Regular Cat CondoDeluxe Cat CondoICU (kittens, geriatric, seizure or immunocompromised pets)

I would like my pet to board*

Sharing with

**If your pet is administered medications during their stay and we are unable to successfully give the medications then they will be separated and 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 permenant marker on each bag.

FREE FEEDING IS NO LONGER AN OPTION. You must provide meals 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?*

Hills Science Diet Sensitive Skin and StomachI brought my own food

Additional Services: I would like to ADD ON

Bath, Brush out & Nail trim (short hair: $50, longhair: $64)Nail Trim ($23.00)Anal Gland Expression ($36.00)

If you would like an Exam during boarding, please list in detail the concerns:

Playtime: Please list the dates you would like to ADD ON playtimes (if your pet is set to stay in our Deluxe Cat Condos then playtimes are included everyday. Please only select this option if you would like EXTRA playtimes on certain days for $14.00 each)

In the past 14 days, has your pet had any of the following*

Has your pet boarded at another facility in the last 14 days?*

If yes to either of the 2 above questions please explain:

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

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 $7.00 charge (regardless of the quantity of medications given at that time).

If yes, list name/last given and please complete our Medication Administration Form on our Website for detailed instructions.

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

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, {ownersName}, 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 Hospital 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 UNDERSTAND THAT IF MY PET IS MEDICATION, AT MY REQUEST OR DUE TO ILLNESS, THAT THERE IS A $5.00 CHARGE FOR A TECHNICIAN TO ADMINISTER MEDICATION, PER TREATMENT TIME/DOSE.

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

Please Initial that you have read the Disclaimer above.*

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*