Boarding Consent Form

Boarding Consent Form
Owner's Name*

First NameLast Name
Client ID No.*
Email*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Pet's Name*
Pet's ID No.*
Species*
Breed*
Age*
Sex*
I hereby consent and authorize Colonial Park Veterinary Hospital to board my pet.

I do hereby release Colonial Park Veterinary Hospital and its staff of any responsibility and/or liability in the absence of gross negligence in the event that this animal should injure itself, refuse food, become ill, or die while boarding.

I will assume full and financial responsibility upon my return. I understand that this is a hospital and that there are sick animals in this facility. I also understand that there is always a risk that my pet could become sick.

I understand that Colonial Park Veterinary Hospital is boarding my pet as an added service to me for my convenience.

Initial here* I understand the risk of boarding my pet here, and I give my permission to treat my pet in any event of illness and/or injury incurred during their stay with a limit of $250.
Initial here* If your cat or dog is not current on all vaccines including Bordetella, a
heartworm test and preventative for dogs, it will be vaccinated and tested upon arrival.

This release will remain on permanent file unless otherwise designated.
Boarding From*
Boarding To*
Medications
Diet
Emergency Contact*

First NameLast Name
Symptoms
Vaccinations
Other problems needing to be checked
Nail Trim

YesNo
Bath

YesNo
By checking this box I agree that all charges rendered are due at the time of service.*

I agree
Signature*

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Date*

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Date
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