Owner’s Name* First Last Phone Number*Pet’s Name* Breed* Sex* Color* Species* Cat Dog Boarding Check in* MM slash DD slash YYYY Boarding Check Out* MM slash DD slash YYYY I understand that state law requires Rabies vaccination for all pets. I also understand clinic policy requires Distmeper/Parvo and Bordetella vaccinations for dogs and Feline Distemper for cats be current. My pet must have official documentation of current vaccines from previous veterinarian or place of professional vaccination. If such documentation is unavailable or if my pet’s last set of vaccines are expired, it is required that my pet is vaccinated at the time of drop off. If my bites another animal or person while at this veterinary clinic, I will provide written evidence of a current Rabies vaccination with 24 hours of notification to do so.* I understand *** PLEASE NOTE: ALL PATIENTS WILL RECEIVE A CAPSTAR UPON ARRIVAL IF FLEAS ARE PRESENT**** Owner InitialCATS CURRENT ON VACCINES?Please choose Yes or No for all of the following questions:FVRCP* Yes No RABIES* Yes No DOGS CURRENT ON VACCINES?Please choose Yes or No for all of the following questions:DHPP/DHLPP* Yes No BORDETELLA* Yes No RABIES* Yes No INTESTINAL PARASITE EXAM WITH IN THE LAST 6 MONTHS. (If not current it would have to be done day of stay.)* Yes No IS PET CURRENTLY ON ANY MEDICATION?* Yes No PLEASE LIST THEM BELOW*Is the dog on heartworm prevention?* Yes No Any vomiting, coughing, sneezing or diarrhea?* Yes No Is your pet allergic to any drugs?* Yes No Current Diet*How many times a day does the pet get fed? & how much?* OPTIONAL SERVICES AVAILABLE AT ADDITIONAL CHARGE* Playtime (15 mins.): $15(per day) Busy Buddy Kongs: $5 (per day) (Pumpkin, Peanut Butter, or GI Canned Food) Additional Walk (M-F): $5(per day) Bath dismissal will be done on the day before pet leaves (if pet is being picked up on Mon. Bath will be done on Fri.) None of the options above I understand you CANNOT guarantee the health of my pet. Pets that are so young that they have not completed their entire series of vaccinations may not yet be protected and, thus, owners accept any risks of infection. I understand and will not hold the clinic responsible for conditions that are unavoidable in boarding kennels, such as but not limited to weight loss, hair loss, upper respiratory infections, bronchitis, diarrhea, and fleas. [understand ALL pets admitted to the clinic must be protected against communicable diseases and must be free of fleas and internal and external parasites or will be treated on entry or discovery at the owner/agent's expense. If vaccinations were performed elsewhere, I can provide written documentation of the Rabies vaccination administered by a licensed veterinarian within 24 hours of notification to do so in the event my pet should bite any person or other pet while on the clinic premises.* I understand I understand that in the event of my pet's illness, the staff will immediately attempt to contact me or my agent to discuss the problem and treatment options but may not be able to contact me immediately and is therefore authorized to initiate appropriate treatment until I or my agent can be reached.* I understand If any problem is observed or develops (PLEASE CHOOSE ONE OF THE FOLLOWING OPTIONS):* Please treat my pet as required; you need not call me. Perform only emergency and supportive care. Notify me for permission to begin any other treatment. Do NOT perform any diagnostics and/or treatment until I am notified and consent for you to evaluate and treat as recommended. Should an EMERGENCY arise, I authorize the medical staff to sedate my pet and/or perform such emergency procedures as may be necessary for the health of my pet until I can be notified. I agree to pay, in full, all charges for necessary services rendered for and to my pet.* I authorize I understand that the clinic is not responsible for loss or damage to personal items left with the pet including but not limited to leashes, collars, toys, and bedding.* I understand The clinic is to use all reasonable precaution against injury, escape, or death of my pet. The clinic and staff will not be held liable for any problems that develop provided reasonable care and precautions are followed. If dogs in heat are boarded, there is always a chance of intact males boarding as well – clinic does everything possible to keep animals separate, but owner understands boarding while in heat is not recommended. I understand that any problem that develops with my pet will be treated as noted above and I assume full responsibility for the treatment expense incurred.* I understand Name & Phone Number(s) of Responsible Party(s) to Be Reached in an Emergency*NameRelationshipPhone Owner Signature*Date* MM slash DD slash YYYY CAPTCHA Δ
