Pet Boarding Waiver and Consent Form

Pet Boarding Waiver and Consent Form

Lake City Animal Hospital
Boarding Start*

MonthDayYear
DateHourMinutesAM/PM Option
Boarding End*

MonthDayYear
DateHourMinutesAM/PM Option
Pet Owner Information
Owner's Name*

First NameLast Name
Owner's Email*
example@example.com
Owner's Phone Number*

Area CodePhone Number
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Owner's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pet Information
Pet's Name*
Breed Type
Color
Pet Temperment
Anything we need to know about your pets temperment/preferences?
Diet*

Owner's FoodHouse Food
Feeding Instructions*
Amount/How Often IE: 1 cup dry food twice daily.
Any Food Allergies/Restrictions?*
Medications
Veterinary Services
(Select above if your pet needs to be seen by the Veterinarian while staying with us.)
Spa Bath - Pets boarding 2 or more nights receive a complimentary Spa Bath which include: Shampoo, Ear Cleaning, Nail Trim *Not offered to pets that require sedation* *Anal Gland Expression is an additional service and not included with a Spa Bath*

Agree to full Spa BathDeclines BathNail Trim OnlyDeclines Nail Trim
Who can we contact for a copy of your pets medical/vaccine records? (Location Name/Phone Number)*
If you have a copy of your pets Medical/Vaccine Records upload them here.

Browse Files

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Pets that are unable to be handled by staff can not be boarded at our facility for the safety of both the pet and our staff. Staff MUST be able to leash and remove a Pet from their run safely in order to provide standard of care as well as evacuate your pet in case of an emergency. If you are not sure how your pet will handle the stress of boarding we recommend scheduling an overnight stay PRIOR to your planned trip. This way you are able to find alternative arrangements if needed.*

I awknoledge I have read and understand the policy above.
Boarding Policy/Agreement
1. Required vaccinations and parasite testing:

Cats: FVRCP (Distemper), Rabies.

Dogs: DHPP (Distemper), Rabies, Bordetella.

2. Highly recommended vaccinations:

Dogs: Canine Influenza. Canine Flu is a serious and highly contagious disease for dogs. Two vaccinations administered three weeks apart are required for protection against flu-related pneumonia.

3. External parasites:

Pets are checked for fleas at time of admission. Capstar, a safe and effective flea medication is administered at drop off.

4. Illness:

If a medical problem is discovered, an agent of Lake City Animal Hospital will telephone the owner or emergency contact to discuss the problem and determine the course of action to be taken.

If the owner or emergency contact cannot be reached, the attending veterinarian has my permission to take the necessary steps to diagnose and treat, in accordance with current medical standards. In case of emergency, measures to preserve and stabilize vital function shall be taken immediately.

5. Agreement:

This is an agreement between Lake City Animal Hospital (LCAH) and the pet owner and charges for boarding services requested and all veterinary costs for the pet(s) during the period said pet(s) is in the care of LCAH. By signing this Agreement and leaving pet with LCAH, Owner certifies the accuracy of all information given about said pet and ownership thereof.

Owner agrees to be solely responsible for any and all acts or behavior of said pet while it is in the care of LCAH, to include injury to other animals and humans. Owner certifies that said pet(s) has not been exposed to communicable diseases within the last 30 days and has not bitten any person in the last 10 days.

LCAH pledges to give appropriate care to all boarded pets. LCAH takes the responsibility for the safety and care of your pets very seriously. The boarding facility is not staffed overnight; however, the facility is a well maintained environment with a monitored alarm system to ensure safety.

Owner will not hold LCAH responsible for conditions that often are unavoidable in boarding environments such as, but not limited to, weight loss, rough hair, skin irritation, cough, infectious respiratory disease such as canine influenza and Bordetella, bloat and sudden death.

In case of a medical emergency I acknowledge the LCAH staff may not be able to immediately contact me and is therefore authorized, in its sole discretion, to perform veterinary services, procedures, emergency surgery, or administer medicine or give other requisite attention to said pet(s).

Owner hereby agrees to reimburse LCAH for veterinary costs, whether specifically authorized or not. Owner understands that if owner fails to pick up pet(s) within 10 days of specified pick up date said pet(s) will be considered abandoned and will be handled in accordance with the Georgia State Law and that doing so does not relieve owner of financial obligations.

By signing below, I confirm that I have read and understand the information printed above.
Signature*

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Date Signed

MonthDayYear
Date
Should be Empty:

Pet Boarding Waiver and Consent Form

Pet Owner Information

Pet Information

Boarding Policy/Agreement