DAC Cat Boarding Release Form

DOCTON ANIMAL CLINIC

CAT BOARDING INFORMATION AND RELEASE FORM

Phone Number where we can reach you while cat is boarding:

Local agent we should contact in an event of an emergency:

Address: Street Phone (home/cell):
Owner's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number where you can be reached while your cat is boarding.

Area CodePhone Number
Name of Local Agent to contact in the event of an emergency

First NameLast Name
Local Agent's Phone Number

Area CodePhone Number
Cat's Name
Cat's Age
Be sure to indicate age in years, months or weeks
Description of Cat
Longhair/shorthair and color
Drop off date (8:30-12:00 or 2:30-5:30 M-F or 8:30-12:30 Saturday, Closed Sunday)

MonthDayYear
Date
Pick up date/time (8:30-12:00 or 2:30-5:30 M-F or 8:30-12:30 Saturday, Closed Sunday)

MonthDayYear
Date
Price is $22-$25 per day, if medication/insulin is required. Boarding scheduled over a weekend will incur a Boarding Trip Fee of $5 per trip to the clinic. This fee is per trip, not per cat for families boarding more than one cat.

Food: We feed Purina DM dry and canned food. If your cat is on a special diet, or has a preference for other food, please bring enough for his/her stay.
Feed Preference

Please feed Purina DM dry and canned provided by the clinic.I will provide food for my cat
My cat's feeding preferences (canned and/or dry, frequency)
My cat's medication and instructions:
Flea preventative and date last applied:
Please list toys, blanket or anything you will bring so that we may keep track of it:
A current FVRCP and Rabies vaccine is required. The Leukemia vaccine is strongly recommended. Please accept or decline the Leukemia vaccine if you cat is not already vaccined.
While my cat is boarding, please perform the following if due:

Annual examFVRCP VaccineRabies VaccineLeukemia VaccineApply Flea PreventionDewormNail Trim
In the event of sickness or death of the pet, please DO or DO NOT contact me or my local agent.*
If I or my local agent cannot be contacted, I DO or DO NOT authorize treatment.*
If treatments are needed, the cost will be the standard fee schedule of Docton Animal Clinic. I place the following restrictions on treatment:*
This answer can be a monetary value restriction or other note to our staff to guide us in your absence.
In the event that I fail to pick up the pet on the date indicated above, I understand that I have 72 hours for myself or my contact agent to contact Docton Animal Clinic to arrange a new pick up date. I also understand that Docton Animal Clinic will make a good faith effort to contact me or my local agent in writing or by phone in such a case. I understand that after the 72 hour waiting period, Docton Animal Clinic may dispose of the animal as they see fit, which may include humane euthanasia. I understand that I will be responsible for all charges incurred. In the event of death of the animal, I understand that I have 30 days to pay the balance due.

Boarded pets will only be released DURING REGULAR OFFICE HOURS. They WILL NOT be released before or after hours and not on Sunday. I hereby consent and authorize Docton Animal Clinic to keep and care for the above named animal. I understand that all reasonable precautions to prevent injury or escape will be used. I have read and agree to the above.
Signature*

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