Boarding Form

Boarding Admission Form

Owner's Name*

Pet's Name*

Breed*

Age*

Sex*

Vaccination History:*

My pet is current on all required vaccinations.My pet will need vaccinations updated.

Vaccination Policy:

I understand that state law requires Rabies Vaccination for all pets. I also understand clinic policy requires Distemper/Parvo and Bordetella Vaccination for dogs and/or Feline Distemper Vaccine for cats to be current. If my pet bites another animal or person while at the clinic, I can and will provide written evidence of a current Rabies Vaccination with in 24 hours of notification.

OWNER INTIAL*

Is your pet current on heartworm prevention? I understand ALL pets admitted to the clinic must be protected against communicable contagious diseases and must be free of internal parasites or will be treated on entry or discovery at the owner’s expense.*

YesNo

Is your pet on flea and tick prevention? I understand ALL pets admitted to the clinic must be protected against communicable contagious diseases and must be free of external parasites (flea and ticks) or will be treated on entry or discovery at the owner’s expense.*

YesNo

Has your pet been checked for intestinal parasites in the last 6 months?*

YesNo

Is your pet currently having any vomiting and/or diarrhea?*

YesNo

Is your pet currently coughing and/or sneezing?*

YesNo

Has your pet had any illness or injury in the last 30 days?*

NoYes, please explain?

Does your pet have any allergies?*

NoYes, please list below

Is your pet currently on any medications?*

NoYes, please list these medications?

What is your pets current diet and feeding schedule? (we recommend bringing your pets food while boarding to prevent GI upset, if you do not we will provide food)*

Optional serviced available at additional charge:

Dismissal bath with nail trim and ear cleaning $25 (if you chose this option please inform us what time you would like to pick up your pet).Playtime $2.50 for once a day. If you choose playtime and your pet does not get along with other, please let us know so we can make sure they have playtime by themselves.Nail Trim $10Ear Cleaning $10

Medical services requested at additional charge:

Update vaccinationsFecalHeartworm testOther

Drop off date*

Date

Pick up date*

Date

Owner Release:

I understand you CAN NOT guarantee the health of my pet. I understand and will not hold the clinic responsible for conditions that are unavoidable in boarding kennels, such as but not limited to weight loss, upper respiratory infections, bronchitis, diarrhea, and fleas. I understand ALL pets admitted to the clinic must be protected against communicable contagious diseases and must be free of internal and external parasites or will be treated on entry or discovery at the owner's expense. 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.

I understand in the event of my pets illness, the staff will immediately attempt to contact me or my agent to discuss the problem and treatment options, but may not be able to contact me immediately and is therefore authorized to initiate appropriate treatment until myself or my agent can be reached. If any problem is observed or develops:*

Please treat my pet as required, you need not call me.Perform only emergency and supportive care. Notify me for permission to begin any other treatmentDo NOT perform any diagnostics and/or Treatment until I am notified and consent for you to evaluate and treat as recommended.

Should an EMERGENCY arise, I authorize the medical staff to sedate my pet and perform such emergency procedures as may be necessary for the health of my pet until I can be notified. I agree to pay, in full, all charges for necessary services rendered for and to my pet.

I understand that the clinic is not responsible for the loss or damage to personal items left with my pet including leashes, collars, toys and bedding.

The clinic is to use all reasonable precautions against injury, escape, or death of my pet. The clinic and staff will not be held liable for any problems that develop provided reasonable care and precautions are followed. I understand that any problem that develops with my pet will be treated as noted above and I assume full responsibility for the treatment expense incurred.

I understand there is additional charges for any pet deemed aggressive during the boarding period.

I will call if my pick-up date changes so you can plan accordingly.

Signature

Date

Name and number of responsible party to be reached in an emergency if you are unavailable: