Drop Off Date: ______________________________
Pick Up Date: AM _PM________
Owner Name: _________________________________________________________________
BATH/DIP: ___Yes ___No NAIL TRIM: ___Yes ___No
MEDICATION: ___Yes ___No PLAYTIME: ___Yes ___No
1. ________ / / / /____
2. / / / /____
3. / / / /____
4. / / / /____
Dog: $3.50/$1.50 per additional dog Holidays: $7.00/ $3.50 per additional dog
Cat: $2.50/$1.25 per additional cat Holidays: $5.00/ $2.50 per additional cat
Playtime: Once a day Twice a day Every other day Other________
*Cats must be negative for Feline Leukemia and Feline Aids and be vaccinated for Feline Leukemia to have playtime or board in condo.
Person to contact in case of emergency: _______________________________
Emergency phone number: _________________________________________
I understand that if a medical emergency situation occurs, the clinic will try to reach me by phone. If the clinic is unable to locate me, your animal will be treated at my expense. I hereby authorize emergency treatment ____________ (INITIALS).
I understand that if my pet(s) is presented for boarding while infested with fleas, ticks or intestinal worms, it will be treated at my expense ___________ (INITIALS).
OUR VACCINATION POLICY: To insure the protection of all pets under our care, the following vaccinations must be up to date AND have been given at a veterinary office:
Dogs: DHLPP, Bordetella, Rabies Cats: FDV, Bordetella, Rabies
I have read the boarding requirements and understand the hospital's policies.
Signed: __________________________________ (Owner/authorized agent)
Checked in by: _________________ (Staff Initials)