Boarding Release Form

Client Information

Client ID(Required)

Client Name(Required)

Address(Required)

Street Address

City

State / Province / Region

ZIP / Postal Code

Telephone(Required)

Persons with permission to pick up pet, other than owners listed above

Patient Information

Patient ID(Required)

Name(Required)

Species(Required)

Color

Breed(Required)

Sex(Required)

Age(Required)

Consent

Your Pet may be due for the following VACCINATIONS and/or TREATMENTS: Please call ahead to check with our staff. If your pet is behind on any of their vaccines they will be updated at owners expense.

DOG RABIES

DISTEMPER(DHPP)

BORDETELLA

HEARTWORM TEST

LEPTO

ANNUAL

CAT RABIES

DISTEMPER(FVRCP)

FELINE LEUKEMIA(FELV)

Accept Risks(Required)

I understand that no vaccine is 100% effective and acknowledge that my pet may still contract illness, I accept financial responsibility for any related treatment.

Parasite Requirements(Required)

I confirm that my pet is free of fleas, ticks and lice. If parasites are identified, I authorize treatment at my expense

Health and Special Needs(Required)

I confirm that my pet has not been ill in the past 30 days and does not pose a health risk to other animals. I understand that young, senior, or special-needs pets may be at increased risk for stress, illness, or injury while boarding and I accept those risks

Medications

Medication Aprroval(Required)

I agree to provide all medications in the original pharmacy containers with clear labeling.

List medications if applicable:

(pets name) is on the following MEDICATIONS ($4.05 )per day to administer oral/topical, ($7.00) per insulin injection)

These medications have already been given today(Required)

Yes

Feeding Instructions

I understand that prescription diets may be purchased at the Facility if not provided.(Required)

Will eat KENNEL REGULAR

OWN FOOD

How much?

How often?

Grooming and Hygiene Services(Required)

I would like (Pets name) to receive a BATH while boarding.(Includes a toenail trim and light brushing. I understand additional grooming time may incur fees)

I decline bathing services

Liability Release(Required)

I release the Facility from any and all claims arising from services provided

I understand and agree that:
My pet may sustain injuries during their stay with us despite supervision.
If my pet harms another pet, I accept responsibility for all related expenses.
The Facility, its employees, and agents are not liable for illness, injury, death, or escape, provided reasonable
care was provided.

Cancellation, Payment, and Pick-Up Policies(Required)

Full payment is due at pickup

Cancellations must be made 48 hours prior to scheduled services to avoid applicable fees.
Pick up is Monday-Friday 7:30am-6:00pm, Saturdays 7:30am-12:00pm, No Sunday pick-ups
If I or my authorized representative fail to pick up as scheduled, I authorize continued
Boarding at my expense.

Media Release(Required)

I grant permission for the Facility to photograph or record my pet for marketing purposes.

I do not grant permission

Veterinary Records Authorization(Required)

I authorize the Facility to contact and obtain veterinary records from my pet’s primary care provider.I release the veterinarian from liability for releasing these records.

In the event of a medical emergency, I authorize transport to the nearest Emergency Client if necessary and accept full financial responsibility of medical expenses incurred.(Required)

In the event of a medical emergency do you give permission to provide CPR and critical care if necessary

I DO NOT give permission to provide CPR or critical care

Maximum Treatment treatment authorized prior to contact $

Acknowledgement& Signature

I have read, understood, and agree to the terms of this Boarding Release Form.This agreement will remain in
effect for future visits for 1 year unless revoked in writing.

Owner Signature(Required)

Date(Required)

MM slash DD slash YYYY

Printed Name(Required)

Contact Number(Required)