Pet Boarding Waiver and Consent Form
Boarding Start
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Month
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Day
Year
Date
Boarding End
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Month
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Day
Year
Date
Pet Owner Information
Pet Owner's Name
*
First Name
Last Name
Pet Owner's Email
example@example.com
Pet Owner's Phone Number
*
Please enter a valid phone number.
Name of Emergecny Contact-For emergency or medical questions while your pet is boarding
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number for a person allowed to make medical decisions for your pet.
Secondary Emergency Contact
First Name
Last Name
Phone Number for Seconday Emergency Contact
Please enter a valid phone number for a person allowed to make medical decisions for your pet.
We will attempt to contact your at the two numbers listed in the event of any emergency, illness, or injury while your pet is boarding. If you cannot be reached, please list the maximum finacial amount your give permission to spent on your pet:
*
Pet Information
Pet's Name
*
Breed Type
Color
Animal Type
Pet Description
Diet
*
Please Select
Purina EN- Canine
Hill's Adult - Feline
Bringing food from home (please list below)
Special Diet
If your dogs is on a prescription diet and we provide that food while your pet is here you will be charged.
Medications
Additional Procedures your pet needs while boarding
*
Please Select
None
Update Vaccines
Heartworm test
Nail Trim
Anal Sac expression
Other
If other please describe
Waiver & Consent
I confirm that I own the pet or I was given authority by the owner for taking ownership of the pet.
I confirm that my pet has a complete and updated vaccination. If vaccinations are not up to date I understand they will be updated while my pet is boarding.
I understand that if fleas are found on my pet, they will be treated with a Capstar tablet, and I will be charged for the tablet. (This is will only kill the fleas for 24 hours and longer-acting flea prevention is recommended at home.)
Signature
*
Date Signed
*
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Month
-
Day
Year
Date
Submit
Should be Empty: