Client Registration and Consent Forms
Lilly's Bespoke Boarding
Owner Name
First Name
Last Name
Owner Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Best Contact Phone Number
*
Alternative phone number (owner).
Vet Details
Vet Practice
*
Vet Address
*
Vet Email
*
Vet Practice Phone Number
*
Vet Out of Hours Phone Number
*
Your local Proxy Details
Who can we call locally, in your absence. This is in the case of emergency only.
Owners Local Proxy Details (EMERGENCY CONTACT)
*
Full Name
Email address
Home Phone
Mobile Phone
Street Address and Town
Any other instructions:
Back
Next
Lilly's Bespoke Boarding - Consent Form.
Please tick the boxes to indicate your consent and understanding then sign below. Thank you.
Veterinary Treatment
I agree that in the case of suspected injury or illness to my dog(s), a Veterinary Surgeon (Vet) maybe contacted my dog may be examined, and investigations performed if required (e.g. blood tests, x-rays) and an appropriate course of action will be taken on the advice of the Vet. I understand that where possible any treatments will be undertaken by the dog’s ordinary vet, but may be at the Lilly’s Bespoke Boarding nominated vet, where that’s not possible.
Yes
No
I understand that every effort will be made to get in touch with me or my local proxy to discuss an appropriate course of action for my dog and Lilly’s Bespoke Boarding will endeavour to keep you (or proxy) updated throughout the process. I agree that if my dog has fleas or worms then Lilly’s Bespoke Boarding will take the dog to the Vet to arrange an appropriate treatment and charge the vets bill to me.
Yes
No
Emergency Decision Preferences
In the unlikely event of a sudden and serious deterioration in my dog’s health while boarding, and where a veterinary surgeon advises urgent action in my dog’s best interests, I confirm my preference below:
Please contact me (or my local proxy) wherever possible before any end-of-life decision is made.
*
Yes
No
I authorise Lilly’s Bespoke Boarding to act as my proxy and follow veterinary advice without delay if required for welfare reasons.
*
Yes
No
I would like to record specific guidance (optional):
*
Yes
No
Please specify your wishes here
Mixing with other dogs.
I consent to my dog(s) mixing with resident dogs. I also consent to my dog(s) being housed separately from incoming dogs whilst boarding at Lilly's Bespoke Boarding in the event of ferry delay, late pick up or emergency situation.
Yes
No
I consent for my dog(s) to use the garden with the resident dogs.
Yes
No
For owners boarding more than one dog: I consent for my dogs to be kept together.
Yes
No
Not applicable
I consent to my dog(s) being fed with (at the same time and place) Resident dogs, on the understanding that they will be kept separated.
Yes
No
I give explicit written permission for my dog(s) to be housed at the same time as known, regular dog who has already been assessed by Lilly's Bespoke Boarding. I understand dogs will only occur if it is deemed safe for all dogs, and dogs only mix if assessed as safe and compatible.
Yes
No
Walking
I consent for my dog(s) to be walked outside of the home environment or garden.
Yes
No
I consent for my dog(s) to be let off a lead outside of the home environment.
Yes
No
Other
I consent to my dog(s) being walked with our resident dogs (never exceeds 5 dogs with 2 people,
Yes
No
Other
IF YOUR DOG NORMALLY USES A CRATE:
I consent to my dog(s) being kept in their crate as part of their normal routine.
SOCIAL MEDIA:
I consent to Lilly's Bespoke Boarding using photographs taken of my my dog(s) during their stay on social media.
Signature - I have read and understood the terms above and have given my consent where indicated.
*
Date
*
-
Month
-
Day
Year
Date
Preview PDF
Submit
Should be Empty: