Direct Release Request - Kauai North Shore Animal Clinic

Please indicate one of the following:*

This is my first Direct Release and I am NOT a client of Kauai North Shore Animal ClinicThis is my first Direct Release and I AM a client of Kauai North Shore Animal ClinicThis is NOT my first Direct Release and I AM a client of Kauai North Shore Animal Clinic

Today's Date*

Today's Date

Please check this box to indicate this is a new arrival (REQUIRED)*

New Arrival

Date of arrival*

Date of Arrival

Time Of Arrival (into LIH airport):*

Hour Minutes

AM/PM Option

If your date of arrival is less than 30 DAYS from today, please also submit written confirmation from the Animal Quarantine Station that they will issue the NIIP in time for your arrival:*

My arrival date is MORE THAN 30 days from today (no documentation needed)My arrival date is LESS THAN 30 days from today and I will submit AQS confirmation documentation to info@kauaidirectrelease.com.Other

While we are happy to perform Direct Release Inspections in less than 30 days, the Animal Quarantine will not issue a permit (NIIP) in that timeframe.

Airline AND flight number (flight number only will not be sufficient)*

Please only provide the airline and flight number that is arriving at LIH. DO NOT provide any connecting flight information.

*If flying private, please provide the aircraft, state tail # or name of carrier service. Also provide the name of the FBO (Fixed Based Operator), either Signature Aviation or Atlantic Aviation at Lihue Airport. Requests cannot be processed without this information*

Owner name*

Owner phone number*

Owner e-mail: Your Neighbor Island Inspection Permit (NIIP) will be emailed to you by the Animal Quarantine Station. Please ensure you monitor your inbox for the NIIP.*

example@example.com

Address: (if you are relocating to Kaua'i please give Kaua'i address)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

**If any information is incomplete or microchip number is incorrect, the confirmation will

be returned to you for correction.

*****PLEASE REACH OUT TO YOUR AIRLINE IF YOU ARE UNSURE HOW YOUR PET IS TRAVELING. The wrong selection will delay the release process and may incur additional fees.*****

If your pet is traveling in the cabin the inspector will either meet you at the end of the jetbridge as you enter the terminal or as you enter the baggage claim area.

If your pet is traveling as checked baggage the inspector will meet you at the elevators in the baggage claim area.

If your pet is traveling as cargo the inspector will meet you at your airline's cargo facility. The cargo facilities are located a short walk from the passenger terminal. Please arrive promptly at the cargo facility upon arrival.

Pet #1 Name (first name only)*

Pet #1 Microchip*

Please DOUBLE CHECK this number for accuracy!

Pet #1 Species*

Pet #1 Color*

Pet #1 Age (please indicate months or years)*

Pet #1 Gender*

Pet #1 Breed*

Is Pet #1 travelling:*

In the cabin with you.Checked baggage (you are on the same flight and you are checking your pet in at the airline ticket counter)Cargo (your pet is oversized or you are not travelling on the same flight - you are checking your pet in at the airline's cargo facility)

Add 2nd Pet*

YesNo

Pet # 2 Name (first name only)*

Pet #2 Microchip*

Please DOUBLE CHECK this number for accuracy!

Pet # 2 Species*

Pet #2 Color*

Pet #2 Age (please indicate months or years)*

Pet #2 Gender*

Pet # 2 Breed*

Is Pet # 2 travelling:*

In the cabin with you.Checked baggage (you are on the SAME flight and you are checking your pet in at the airline TICKET counter)Cargo (your pet is OVERSIZED or you are NOT travelling on the same flight - you are checking your pet in at the airline's CARGO FACILITY)

Add 3rd Pet*

YesNo

Pet # 3 Name (first name only)*

Pet # 3 Microchip*

Please DOUBLE CHECK this number for accuracy!

Pet # 3 Species*

Pet # 3 Color*

Pet # 3 Age (please indicate months or years)*

Pet #3 Gender*

Pet # 3 Breed*

Is Pet #3 travelling:*

In the cabin with you.Checked baggage (you are on the same flight and you are checking your pet in at the airline ticket counter)Cargo (your pet is oversized or you are not travelling on the same flight - you are checking your pet in at the airline's cargo facility)

Add 4th Pet*

YesNo

Pet # 4 Name (first name only)*

Pet # 4 Microchip*

Please DOUBLE CHECK this number for accuracy!

Pet # 4 Species*

Pet # 4 Color*

Pet # 4 Age (please indicate months or years)*

Pet #4 Gender*

Pet # 4 Breed*

Is Pet #4 travelling:*

In the cabin with you.Checked baggage (you are on the same flight and you are checking your pet in at the airline ticket counter)Cargo (your pet is oversized or you are not travelling on the same flight - you are checking your pet in at the airline's cargo facility)

Kauai North Shore Animal Clinic strongly recommends establishing care for your pet so a veterinarian can fully discuss the recommended preventative care necessary for a pet living in or visiting Kauai.

Complimentary Exam for New Pets

New Pets arriving on Kauai are offered a complimentary exam (regularly priced exam $73.24) to establish care with Kauai North Shore Animal Clinic.
*valid within 30 days of arrival for regularly scheduled exams.

Discounted Exam for Pets Returning to Kauai

Pets returning to Kauai are offered a 50% discount on exams scheduled within 30 days of arrival.
*valid within 30 days of arrival for regularly scheduled exams.

Would you like to schedule an appointment to have your pet be seen by the veterinarian at our clinic? We recommend scheduling at least 3-5 days after your arrival in Kauai!*

YesNo

Appointment Request #1*

Appointment Request #2

Secondary Owner*

YesNo

Secondary Owner Name

First NameLast Name

Secondary Owner Phone Number

Please enter a valid phone number.

Secondary Owner Relationship

Secondary Owner may make the following decisions:

FinancialMedicalDrop off/pick upOther

Would you like us to request records from your previous veterinary clinic?*

YesNoI will upload or send previous recordI will request my previous veterinary clinic send records to: admin@kauainorthshoreanimalclinic.com

Previous Veterinary Clinic

Clinic's Phone Number

Please enter a valid phone number.

Upload previous medical record

Our goal is to provide you with extraordinary care & service. Is there anything we can do to give you the best experience?

I agree to the following terms and confirm all of the information I have provided is correct.

I confirm the flight information I have provided is correct.
I confirm this flight originates from the mainland and Lihue is my pet's first port of entry into the state of Hawaii. *Flight changes are subject to a $50 flight change fee.
I understand additional booking fees will apply to the following:
- Flights that arrive AT or AFTER 5:00 PM, or AT or BEFORE 8:00 AM
- Flights that arrive on Saturday or Sunday
- Flights that arrive on a State or Federal Holiday, in addition to New Years Eve, Easter Sunday, and Christmas Eve.
I understand if my pet's arrival will be more than 30 minutes different than my scheduled Direct Release booking I am required to send a Flight Change Form (found on the Direct Release drop down menu). Flight changes must be received via the Flight Change Form
I understand that if I fail to update KNSAC of travel changes or do not arrive as scheduled I will forfeit all booking fees.
I understand that KNSAC will not confirm my appointment with the AQS until I have paid my invoice in full. Submitting this form does not guarantee a Neighborhood Island Inspection Permit (NIIP) will be issued from the AQS.
I agree it is solely my responsibility to confirm all requirements, set forth by the Animal Quarantine Station, have been met to allow my pet to be released on Kauai by Kauai North Shore Animal Clinic.
I have followed all of the requirements on Checklist 2 provided by the Hawaii Department Of Agriculture. THIS INCLUDES: Having an up to date FAVN result for my pet(s), submitting the AQS-279 form, submitting the 2 most recent Rabies Certificates, and sending payment via mail to the HDOA for their fees.

REFUND POLICY:

I understand cancellations prior to two weeks before arrival will receive a full refund less $150 processing fee.
I understand cancellations within two weeks of arrival will recive a 50% refund.
Cancellations less than 48 hours or less prior to arrival are not refundable. A 50% credit may be applied to a future booking.

By signing below I agree the information I have provided above is correct. I understand all requirements for entry and associated fees and policies.

Signature*

DO NOT refresh after submitting, it may take several moments to be finalized. Do not back out, please be patient with the system and stay on this page until you see the "Thank You!" page load. Mahalo!