Boarding Slip

Pet’s Name________________________ Owner’s Name______________________
Drop Off Date________Pick Up Date_________AM/PM Bath/Groom_________
Would you like any treatments done to pet(i.e., vaccinations, nail trim, exam, anal glands expressed)?________________________________________________
Feeding Instructions___________________________________________________
Special Instructions(meds to give, etc.)____________________________________
____________________________________________________________________
Items brought in with pet_______________________________________________
____________________________________________________________________
Please specify the area in which you would like your pet boarded (check 1 box):
Dogs: Cats:
Cages (for dogs under 60 pounds only)
Cages
Runs
Cat Condos
Luxury Suites
 

Would you like your pet to receive either of these special boarding options? (check box):

Private Playtime/Exercise Session = $10.00 per day (30 minute session); specify # of days: _______
Daily Brushing = $5.00 - $7.00 per day (depending on size of pet & mats); specify # of days: _____

OWNER RELEASE 
I understand you CANNOT guarantee the health of my pet. 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. I understand ALL pets admitted to the clinic must be protected against communicable contagious diseases and must be free of internal and external parasites or will be treated on entry or discovery at the owner / agent’s expense.
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 myself or my agent can be reached.
If any problem is observed or develops (Check one box):

 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 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 that my pet can only be discharged during REGULAR office hours.
I have been provided with a copy of the boarding policy handout/brochure explaining the clinic’s boarding policy, and have read and agree to all policies.

Date:_________________
Owner/Agent:____________________________________________
Name & Phone # of Responsible Party to be Reached in Emergency:
________________________________________________________________