Montpelier Boarding Release Form

Boarding Release Form
Welcome to our hospital! Thank you for giving us the opportunity to care for your pet(s). Please help us meet your needs better by taking a moment to complete this information sheet.

*=required
Client Information
Owner Name*

First NameLast Name
Pet Name*
E-mail*
example@example.com
Check-in Date*

MonthDayYear
Date
Check-Out Date (Check-out time is noon. Pets staying after 12pm will be charged an additional day of boarding, unless we are giving a bath.)*

MonthDayYear
Date

Date Of Last Vaccinations:*

Rows	Date
Canine DHPP/DHLPP
Rabies
Bortadella
Flu
Feline FVRCP
FELV
Rabies

Please List Medications, Dosages And Times They Are To Be Given, If Necessary. (A Medication Fee For Oral Medications Of $3 Will Be Charged For Each Dose Administered; Injection Fees Vary):*
Have Any Medications Been Given Today, And If So, What Times?*
Items Left With Pet (Including Any Special/Prescription Diets; If Pet Is On A Presecription Diet And You Did Not Bring The Food, You Will Be Invoiced For The Bag And/Or Cans.): *
Feeding Schedule And Amount Fed:*
YesNo
YesNo
If Yes, How Many?
YesNo
If Yes, How Many Playtime Sessions?
Additional Notes Or Special Requests:
Requirements for Boarding (please read each statement before you sign below):
- All pets must be current on all vaccinations. If any vaccines are required, a physical examination and vaccination will be performed by a veterinarian. Standard fees will apply.
- All pets must be free of external parasites (i.e. fleas, ticks) or they will be treated at the owner’s expense.
- Montpelier Veterinary Hospital has my permission to perform needed treatment should an illness or emergency arise. If I cannot be reached at the emergency contact number above, I consent to whatever medical or surgical care the veterinarians deem necessary, including referral to a 24-hour emergency hospital if needed.
- Diabetic pets requiring insulin will be charged for any glucose readings needed while they are boarding, under the veterinarian’s discretion. Standard fees will apply.
- I release Montpelier Veterinary Hospital and all of its employees from any liability that could result from loss or injury of my pet.
I have read the boarding release form and understand the hospital’s policies. Signature of Owner or Authorized Agent::*
Today's Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Boarding Release Form

Welcome to our hospital! Thank you for giving us the opportunity to care for your pet(s). Please help us meet your needs better by taking a moment to complete this information sheet.

Client Information