Boarding Admission Form

Clinton Parkway Animal Hospital Pet Boarding Form
Name *

First Name Last Name
Pet's Name *
Phone Number *

Area Code Phone Number
E-mail *
Name & phone number of responsible party to be reached in case of emergency
Date of arrival *

Month Day Year
Date
Arrival Time *

Morning Afternoon/Evening
Date picking up *

Month Day Year
Date
Pick up time *

Morning Afternoon/Evening
All pets are fed Hill's premium diets unless you have brought a special diet. *

Feed CPAH diet Will bring my pet's diet.
Feeding Schedule *

Once a day Twice a day
Amount per feeding *
Our canine friends enjoy 4 daily walks in our outdoor exercise area. We are proud to offer the latest walk for dogs in Lawrence! Our last walk is at 7pm—a later walk helps your pet have a more comfortable night!
Please mark any additional services for your pet

Bath-20% savings with a 3 day stay (free nail trim) Nail trim (20% savings)
Medication to be given while boarding: ($3.80/once a day, $6.85/2-3 times a day)
Please have one of the doctors check my pet for:
Note: There will be a minimum doctor medical exam charge for this evaluation.
For the safety and health of all boarding pets, any vaccines due will be updated while your pet is staying at our hospital. All dogs must have a negative stool check within the last 12 months and be free of fleas and/or ticks or will be treated while at our hospital.
In case of an emergency, while your pet is being boarded and you cannot be reached, I authorize CPAH to do whatever is necessary to treat my pet.
E-Signature--You can use your mobile phone, mouse or touch screen device to sign this document. Click the "Submit" below when finished.

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Clinton Parkway Animal Hospital Pet Boarding Form