Benson Animal Clinic Boarding Form

Benson Animal Clinic Boarding Form

All boarding animals are required to be up to date with vaccinations 2 weeks prior to boarding. Dogs are required to have Rabies, Dapl (DHLP), and Kennel Cough Vaccines. Cats are required to have Rabies and Fvrcp Vaccines.
Owner Contact Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Emergency Contact Information
If we cannot reach you, we will use this contact information instead.
Drop-Off Date

MonthDayYear
Date
Pick-Up Date

MonthDayYear
Date
Pet Name:
Pet Description:
Breed, Sex, Age, etc.
Is your pet spayed or neutered?

YesNo
Is your pet up-to-date on all required vaccinations?

YesNo
Is your pet on any medications or prescription diets?

YesNo
If so, please list any special instructions below:
Medical Records/Information:

Please upload any former medical records, vaccinations, etc. that you would like added to our records.
Cancelof
Belongings
Please list any belongings that will be included during your pet's stay.
*Please note we are not responsible for lost/damaged items. We highly recommend including a separate list of belongings. Toys we feel are dangerous to give to dogs will not be given.*
Feeding Habits:
Clinic Food or Own Food

ClinicI will bring my own food
Feeding Instructions:
Food Allergies:
Leave blank if unknown or your pet has no present allergies.
Extra/Additional Instructions:
Please add any relevant information that will make your pet's stay easier.
Bathroom Habits:
Leash Walk OutsideDo Not Walk Outside (Potty Pads)Litterbox (Cats Only)
Dogs are walked outside twice daily.

*If your dog is an exuberant leash-puller, jumper, or runner, you may find it a better option to board at a facility that has a fenced in area.*

Dog boarders are walked on a leash in our unfenced backyard 2-3 times daily. We make ALL attempts to make sure walks are pleasant and safe and all dogs are walked individually. *We are not responsible for any dog that breaks free due to faulty leash/harness/collars, or exuberance.

If you believe your dog may escape during a walk, please let us know in person when dropping off for boarding.
Behavioral Habits:
Does your dog chew up blankets and/or toys?*
(Dogs at risk of ingesting blankets/toys will not be given any blankets/toys.) **We are not responsible for dogs that ingest fabric and develop a foreign body while boarding.
If your dog is excessively vocal or destructive, do we have your permission before to administer a mild sedative to relax your dog while boarding?*

YesNoCall Before Administering
Boarding Fees are as follows (tax not included):

**Maximum Stay of 2 weeks**

Dogs: $30/Night

Cats: $20/Night

Special Needs: $40/Night

Holiday Fee: $40 flat rate in addition to nightly rate

Weekend Fee: $40 flat rate in addition to nightly rate

**Saturday and Sunday are equal to $50/night**

Boarding Terms and Services:

*Signing this form means you agree and accept our terms for boarding.

*Dogs/Cats must be up to date on vaccines and spayed/neutered in order to board. We are not responsible for dogs that develop a cough while boarding as a bordetella vaccine is required two weeks prior to boarding.

*Pets who have diarrhea are given Metronidazole (Anti-diarrheic) while boarding at charge to the owner.

*Dogs who do not have their own food, will be given Science Diet Sens Skin & Stomach Dry Kibble (Included in cost of boarding). Dogs who refuse to eat their food are offered a can of Science Diet I/D Chicken Stew. There is a $3.70 charge per can of food given.

*Pets will be checked for fleas. If fleas are found, a treatment will be given at the owner’s expense.
*In the event that your pet(s) become sick and/or injured, do you consent for Dr. Zimmerman to examine and treat your pet accordingly?*

YesNoCall before treating
ILLNESS/INJURY WILL BE TREATED AT THE OWNERS’ EXPENSE.

**ANY ILLNESS/INJURY THAT OCCURS AT THE FAULT OF OUR STAFF WILL BE COVERED BY THE BENSON ANIMAL CLINIC**
ANY PET NOT PICKED UP WITHIN THREE DAYS OF SCHEDULED PICKUP CAN AND WILL BE CONSIDERED ABANDONED UNLESS PRIOR ARRANGEMENTS/COMMUNICATIONS ARE MADE. ALL ATTEMPTS WILL BE MADE TO CONTACT OWNER: WE RESERVE THE RIGHT TO SURRENDER ANY ANIMAL DEEMED ABANDONED TO THE NEBRASKA HUMANE SOCIETY.
I agree with and understand the terms listed above in this document. By agreeing to this form I also understand that the Benson Animal Clinic reserves the right to deny boarding services if my cat/dog is aggressive, unruly, overly anxious, and/or unable to be handled. Benson Animal Clinic also reserves the right to surrender an animal deemed abandoned to the Nebraska Humane Society.*

I agree to the terms aboveI do not agree with the terms listed above and understand that Benson Animal Clinic will decline any boarding services.
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Benson Animal Clinic Boarding Form

Owner Contact Information

Feeding Habits:

Bathroom Habits:

Behavioral Habits: