Boarding Form

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Emergency contact will be used in case your pet becomes ill and will require immediate medical treatment. We are not a 24 hour facility and will not have a veterinarian on duty after hours or on the weekends after 1pm on Saturday. The emergency contact may be required to pick up your pet and take them to a 24 hour facility for care.

Emergency Contact*

First NameLast Name

Emergency Contact Phone*

Please enter a valid phone number.

Pet's Name*

Breed*

Is your pet allowed to have treats?*

YesNoOther

Does your pet have any food allergies?*

Would you like a bath and nail trim for an additional charge?*

YesNo

I acknowledge that it my pet is not eating to normal standards an easily digestible canned diet will be fed to my pet at an additional charge*

Yes

Is our kennel staff able to play with your pet?*

YesNo

Would you like to receive texts regarding your pet during their stay?*

YesNo

In the event of an unforeseen emergency are we allowed to proceed with extreme life saving measures at an additional expense that you will be responsible for.*

YesNo

Please list any medications that your pet will need: all medications need to be in the original bottle*

If bringing your own food what is it and what is your pets feeding schedule?*

I understand that in cases of emergency, treatment or general care (ie: diarrhea, vomiting, etc) CAC will make a reasonable effort to contact the number provided. However, if no one can be reached, I authorize Chastain Animal Clinic to provide any care deemed necessary by the doctor on duty. I also understand I will be financially responsible for such care.

Signature*