Westlake Boarding Release Form

Boarding Dates*

Start - End Date

Owner's Name*

First NameLast Name

Owner's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Owner's Phone*

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Name and Phone*

Pet's Name*

Microchip #

Age*

Species*

Breed*

Gender*

Brand and type of food you will be supplying for your pets stay: *

How much and how many times a day should we feed your pet?*

YesNo

If yes please list. *

YesNo

If you answered 'No', oral preventative will be given upon entrance and exit at the owner's expense to prevent flea infestation.

Please list all medications/supplements your pet is currently taking: *

YesNo

Medical Treatments*

Personal Belongings *

Requirements for Boarding
1. All animals must be current on all vaccines.

2. All animals will be treated at owner's expense for any external parasites (ex. ticks, fleas, etc.).

3. WLAH has my permission to do whatever is necessary should an emergency arise.

4. If a tranquilizer is necessary for treatment or handling, WLAH has my permission to administer such medication.

5. WLAH is not responsible for the loss or damage of any personal belongings such as bedding or toys.

6. Canine boarders may be picked up from 7:00am-6:00pm Monday through Friday and from 10:00am-12:00pm on Saturday.

Feline boarders may be picked up from 7:00am-6:00pm at the hospital.
*Pets picked up after 2:00pm will be charged a late pick up fee of $13.
*Pets may not be picked up on Sundays or Holidays.
*Pets receiving medical treatment may be picked up after 2:00pm without being charged.

7. A credit card number or another form of payment is required as a deposit. A payment is required after 14 days and every 14 days thereafter. Lack of payment as specified may be considered abandonment of your pet(s).

YesNo

I understand

Boarding Consent Acknowledgement
I have read the boarding requirements outlined on this consent form and understand the practice’s policies. I certify I am the owner or agent responsible for the animal described above, that I am over 18 years of age, and I have the authority to give lawful consent to the terms and conditions contained in this form.

Printed name of Owner or Responsible Agent:*

Phone number where Owner/Agent can be reached:*

Date:*

I consent to all costs incurred during the process of resuscitation of my pet. I understand that I will incur charges beyond those included in my agreed upon estimate.I decline CPR in the event that it is deemed necessary for the survival of my pet. I understand that by choosing this “Do Not Resuscitate” order on my pet, the medical staff will not perform CPR or give possibly life-saving medications.

I have read and understand these boarding requirements and policies.

Today's Date*

Date

Owner Signature*