Boarding Agreement Form

Owners Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Number needed to send payment information*

Area CodePhone Number

Alternate Contact Number:*

Area CodePhone Number

Email*

example@example.com

Emergency Contact Name OTHER THAN YOURSELF*

Other than owners

Emergency Contact Phone Number*

Other than yours

Avaiable times for pick up and drop off:

Monday - Friday: 8:00 am to 5:15 pm

Sat: 8:00 am to 11:45am

After hour pick up and Holidays (you must prepay for this service):

Sat: 3:00pm - 5:00 pm

Sun and Hoildays: 830am-10am and 330pm-5:00pm:

Date of check in:*

Time of drop off:*

:HourMinutesAM/PM Option

Date of pick-up:*

Date

If weekend or holiday pick up:*

PIck up time for Monday-Friday(non-Holiday) If you are not picking up M-F please type NA:*

1st Pets Name:*

2nd Pets Name*

Put NA If no other pets

3rd Pets Name

4th Pets Name

Additional Pet(s)

	Pets Name	Name of Medication	Dose	How often do we give the Meds? once, twice or 3 times daily and AM OR PM
1st
2nd
3rd
4th
5th
6th
7th
8th

Additional Information Regarding Medications:

Are you providing your own food:*

YesNo

Or do you want us to feed our food to your pet:*

YesNo

Dry food-how Often are we feeding your Pet:*

How many cups per meal:*

Wet food - How often?*

Wet food- how much per serving:*

Special instructions:

Will you be providing? And how often would you like them given?GIve description of treats.

Baths must be scheduled at the time of making your boarding reservation.

Play Time k9 and feline:

	Once Daily	Every other day	Once midway through boarding stay
15min $13.50
30min $20

10 min of K9 Puzzle time $8.00 a day(if added to play time it will be 10 additional minutes:

	Once Daily	Every other day	Once midway through stay
Puzzle time

15 min of Feline interactive time mats $5.00 a day:

	Daily	Every other day	Once midway through boarding stay
water mat with fish inside
mouse chase mat

What does your pet enjoy doing Water play, cuddles, balls, PUZZLE,bubbles, etc...?

K9 Kong: filled with flavored Kong Paste Charge is $3.00 a day:

	every other day	every 3 days	Once midway through boarding stay
Kong Filled with Bacon and Cheese Paste
Kong filled with Liver Paste
Kong filled with Peanut Butter Paste

Pup Cups: $2.00 a day

	every other days	once every 3 days	Once midway through boarding stay
Whip Cream Cup
yogurt Cup

Ice Snacks:

	every other days	once every 3 days	Once midway through boarding stay
yogurt Cup
$3 large dog ice block filled with water, Kibble, strawberries and blueberries
$3 large dog ice block filled with beef flavored water, kibble, strawberries and blueberries
$3 large dog ice block filled with chicken flavored water, kibble, strawberries and blueberries
$2 small dog ice block filled with water, strawberries and blueberries
$2 small dog ice block filled with beef flavored water, kibble, strawberries and blueberries
$2 small dog ice block filled with chicken flavored water, kibble, strawberries and blueberries

K9 Ice Cream $5.00:

	every other days	once every 3 days	Once midway through boarding stay
Vanilla
Carob
Maple Bacon
Peanut Butter

Feline Pup Cups: $2.00 a day

	every other days	once every 3 days	Once midway through boarding stay
yogurt Cup

Feline Churu: $1.00 a day

	Daily	every other day	once every 3 days	once midway through stay
Churu
Frozen Churu

Feline Frozen treats: $2.00 a day

	every other day	once every 3 days	once midway through stay
Sardine on ice
Tuna on ice

Anything special you would like us to be aware of?

I hereby grant Coffee Road Animal Hospital permission to use my likeness and/or my pet’s likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.
I understand and agree that all photos will become the property of Coffee Road Animal Hospital and will not be returned.
I hereby irrevocably authorize Coffee Road Animal Hospital to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.
I hereby hold harmless, release, and forever discharge Coffee Road Animal Hospital from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE.

Do you consent to Coffee Road Animal Hospital publishing and/or posting pictures and video's of your pet?*

YesNo

Today's date:*

Date

Signature of owner or responsible party approving all of the above information:*

BOARDING AGREEMENT (You must call to make reservations prior to completing this form) :

Emergency Contact OTHER THAN YOURSELF that would be able to assist in picking up your pet if needed:

Check In and Out:

For Monday-Friday pick up, please provide time of pick up:

Vaccinations Required:

Pet(s):

Medications:

Belongings: Not allowed at this time

Diet:

Treats:

Add-on requests:

NEW Add-on Furbaby treats for the K9's starting July 24th 2025:

NEW Add-on Furbaby treats for the Feline's starting July 24th 2025:

Photo Release

Payment information for ESTABLISHED clients: