Boarding Information and Release Form

Name*

First NameLast Name

Secondary Name

First NameLast Name

Email

example@example.com

Primary Phone Number*

Secondary Phone Number

Name of Pet - Please fill out one form for each pet to be boarded.*

I understand that this form is not a reservation. I have scheduled boarding reservations with a staff member.*

Initials

Boarding Start Date*

Date

What time are you dropping off that day?*

Boarding End Date*

Date

What time are you picking up that day?*

**I understand that I am boarding at an emergency facility, and that there will be an additional fee of $29.50 if I pick up after hours. Additionally, I understand that there may be an extended wait to pick up if the after hours/weekend staff is helping critical patients.*

Initial

We require the following to be current in order to board at Northwood Animal Hospital: For cats, we require a negative fecal test within 6 months, current rabies and FVRCP vaccines. For dogs, we require a negative fecal test within 6 months, current rabies, DA2PP, Bordetella vaccines. Please select which answer fits best.*

Vaccine Status

If your pet's vaccines were performed at another clinic, please list the name below.

Are you bringing your pet's food?*

Does your pet need to be fed the day of dropping off?*

Yes, they will not have eaten and need to be fed immediately.Yes, they will need to be fed in the afternoon.No, they have already eaten all their meals today.Other

How many times do you feed your pet each day?*

How much do you feed your pet at each meal? (Ex: 1 cup, free feed, 1/2 can, etc.)*

Please note that we feed all boarders Science Diet dry food at no charge unless another diet is provided. If you would like us to feed our in-house wet food, there will be additional charges per can. **For the safety of our staff and other pets, we do not serve raw diets and require any meat-containing diets to be cooked.** By initialing below, I agree that I have read and understand the hospital's food policies.*

Initials

Does your pet need medications the day of dropping off? Please understand that there is a fee of $4.25 per day if medications need to be administered.*

My pet is not on medications.My pet is on medications but will not need them the day of drop-off.My pet is on medications and will need them the day of drop-off.

If pet is on medications, please fill out chart. **We require medications to be in original and labeled packaging. They cannot be in your pets food or pill pockets. We can do that while they are here.**

	Medication Name and Strength	Dose	Frequency	Last time given
Med 1
Med 2
Med 3
Med 4
Med 5
Med 6
Med 7

Would you like your dog bathed before pick-up? Temperament allowing, this includes an ear cleaning, and the cost is $42. We are not able to bathe cats unless it is medically necessary.*

All dogs will be leash walked or allowed in our outdoor runs during the day while here (weather permitting). Cats will be provided with a clean litterbox, to be changed as needed. We offer an additional exercise option of one-on-one leash-free, kennel-free time with a kennel tech for 15 minutes per session (in our grassy exercise yard for dogs, in an exam room for cats). Would you like your pet exercised while boarding?*

If you are boarding more than one dog, understand that it is our default to board them all SEPARATELY. If you are boarding more than one dog, and do not select the following choice, your dogs will be in separate kennels while boarding. Please note that you should only select the following if they HAVE NEVER FOUGHT in the past over any item or situation. Dogs who are boarded together will still always be fed separately. For the safety of all parties involved, cats will never be boarded with dogs. Cats will always be boarded alone. We reserve the right to place them in separate cages at any point during boarding if there are any concerns.

Select this to have multiple dogs boarded TOGETHER

Does your pet have any history of behaviors that our kennel staff should know about?*

No, my pet has always boarded well.Yes, my pet has a history of jumping fences.Yes, my pet has a history of opening gates.Yes, my pet has a history of aggression toward other pets.Yes, my pet has a history of aggression toward people.Yes, my pet is highly anxious and may chew on the kennel door or walls.Other

If you answered anything other than No to the previous question, please elaborate below.

Does your pet have any health issues that our medical staff may need to know? (Examples may include seizures, diabetes, recent surgeries, heart disease, etc.)*

Would you like any other procedures performed while your pet boards?*

Emergency Contact's Name*

Emergency Contact's Phone Number*

Any additional information you think may be important.

Have you received an estimate for this boarding reservation? Please understand that special request foods, baths, exercising, medication administration, and additional requests may not have been included on an original estimate, and payment for all services will be required at pick-up.*

Requirements for Boarding

1. All pets must be current on all required vaccinations. If not current, vaccinations and associated exam must be performed while boarding at the owner's expense.

2. All pets must be free of external parasites (ex. ticks, fleas) or they will be treated at the owner's expense.

3. Northwood Animal Hospital has my permission to perform necessary medical treatments should an emergency arise or my pet becomes ill. I will be financially responsible for said treatment as long as veterinarian made a reasonable attempt to reach me to discuss.

4. If a tranquilizer or sedation is necessary for treatment or handling, or if my pet is at risk for self-harm during boarding, Northwood Animal Hospital has my permission to administer such medication.

5. There is a 5 night minimum charge for pets boarding on major holidays.

6. Boarding pets may be picked up Monday - Friday, 7am - 6:00pm, and Saturday 8am - 12pm. There is a $29.50 pick up fee all day on Sunday, and any time outside of the pickup hours listed. If picking up after regular operating hours please call 850-385-8181 to alert the emergency technician.

PLEASE UNDERSTAND WE WILL NEED TO TREAT ANY EMERGENCIES IN THE HOSPITAL BEFORE CHECKING OUT YOUR PET AFTER REGULAR HOURS.

By signing below, I agree that I have read the boarding requirements and understand the hospital's policies.*