Name
First
Last
Date of booked reservation & length of stay*
Estimated time of drop off*
Estimated time of pick up*
(Discharge is 12 noon, if pet is picked up after 12 noon, another day charge will be applied) Flea Policy: If fleas are found on your pet, they will require treatment upon admission. Cost will vary depending upon medication and dose. Pet Information This section is for ONE pet
Pet's name*
Feeding Instructions*
(ie. 1 cup of kibble twice daily)
Does your pet have any food allergies?*
Should your pet refuse to eat, which diet alternative do you prefer?*
( Soak kibble? Another food from our retail at an additional cost? etc.)
Is there anything we should know about your pet’s behaviour?*
(ie. Anxiety, Aggression, Energetic, etc.)
Has your pet ever bitten anyone? If yes, when?*
Does your pet have any medical conditions we should be aware of?*
(ie. Diabetic, Epileptic, etc.)
Does your pet require any medications? If yes, please list medication(s) and when they are given?*
***All medications must be brought in their original packaging with the prescription label attached***
(Please note that we always check for fleas on admission, if we find any signs of fleas on your pet, they will be treated at the owner’s expense).
Please note that the cost will be $36 per day if your pet requires medication administered by a technician only (any kennel size) Ex. injections
Would you like to have any of the following extras done at an additional cost?* If you selected Extra Play Time, how many days would you like to sign up for?
If you selected Brushing above, how many days would you like to sign up for?
Just a reminder that we do not allow personal belongings such as beds, blankets and toys. Will you be boarding multiple pets with us? If so how many? No 2 pets 3 pets 4 pets 5 pets
Information For 2nd Pet Pet 2 Pet's name*
Pet 2 Feeding Instructions*
(ie. 1 cup of kibble twice daily)
Pet 2 Does your pet have any food allergies?*
Pet 2 Should your pet refuse to eat, which diet alternative do you prefer?*
( Soak kibble? Another food from our retail at an additional cost? etc.)
Pet 2 Is there anything we should know about your pet’s behaviour?*
(ie. Anxiety, Aggression, Energetic, etc.)
Pet 2 Has your pet ever bitten anyone? If yes, when?*
Pet 2 Does your pet have any medical conditions we should be aware of?*
(ie. Diabetic, Epileptic, etc.)
Pet 2 Does your pet require any medications? If yes, please list medication(s) and when they are given?*
(Please note that we always check for fleas on admission, if we find any signs of fleas on your pet, they will be treated at the owner’s expense).
Please note that the cost will be $36 per day if your pet requires medication administered by a technician only (any kennel size) Ex. injections
Pet 2 Would you like to have any of the following extras done at an additional cost?* Pet 2 If you selected Extra Play time Please Enter How Many Days you would like this service:
Pet 2 If you selected Brushing Please Enter How Many Days you would like this service:
Information For 3 Pets Pet 2 Pet's name*
Pet 3 Pet's name*
Pet 2 Feeding Instructions*
(ie. 1 cup of kibble twice daily)
Pet 3 Feeding Instructions*
(ie. 1 cup of kibble twice daily)
Pet 2 Does your pet have any food allergies?*
Pet 3 Does your pet have any food allergies?*
Pet 2 Should your pet refuse to eat, which diet alternative do you prefer?*
( Soak kibble? Another food from our retail at an additional cost? etc.)
Pet 3 Should your pet refuse to eat, which diet alternative do you prefer?*
( Soak kibble? Another food from our retail at an additional cost? etc.)
Pet 2 Is there anything we should know about your pet’s behaviour?*
(ie. Anxiety, Aggression, Energetic, etc.)
Pet 3 Is there anything we should know about your pet’s behaviour?*
(ie. Anxiety, Aggression, Energetic, etc.)
Pet 2 Has your pet ever bitten anyone? If yes, when?*
Pet 3 Has your pet ever bitten anyone? If yes, when?*
Pet 2 Does your pet have any medical conditions we should be aware of?*
(ie. Diabetic, Epileptic, etc.)
Pet 3 Does your pet have any medical conditions we should be aware of?*
(ie. Diabetic, Epileptic, etc.)
Pet 2 Does your pet require any medications? If yes, please list medication(s) and when they are given?*
(Please note that we always check for fleas on admission, if we find any signs of fleas on your pet, they will be treated at the owner’s expense).
Please note that the cost will be $36 per day if your pet requires medication administered by a technician only (any kennel size) Ex. injections
Pet 3 Does your pet require any medications? If yes, please list medication(s) and when they are given?*
(Please note that we always check for fleas on admission, if we find any signs of fleas on your pet, they will be treated at the owner’s expense).
Please note that the cost will be $36 per day if your pet requires medication administered by a technician only (any kennel size) Ex. injections
Pet 2 Would you like to have any of the following extras done at an additional cost?* Pet 3 Would you like to have any of the following extras done at an additional cost?* Pet 2 If you selected Extra Play time or Brushing Please Enter How Many Days you would like this service:
Pet 3 If you selected Extra Play time or Brushing Please Enter How Many Days you would like this service:
Information For 4 Pets Pet 2 Pet's name*
Pet 3 Pet's name*
Pet 4 Pet's name*
Pet 2 Feeding Instructions*
(ie. 1 cup of kibble twice daily)
Pet 3 Feeding Instructions*
(ie. 1 cup of kibble twice daily)
Pet 4 Feeding Instructions*
(ie. 1 cup of kibble twice daily)
Pet 2 Does your pet have any food allergies?*
Pet 3 Does your pet have any food allergies?*
Pet 4 Does your pet have any food allergies?*
Pet 2 Should your pet refuse to eat, which diet alternative do you prefer?*
( Soak kibble? Another food from our retail at an additional cost? etc.)
Pet 3 Should your pet refuse to eat, which diet alternative do you prefer?*
( Soak kibble? Another food from our retail at an additional cost? etc.)
Pet 4 Should your pet refuse to eat, which diet alternative do you prefer?*
( Soak kibble? Another food from our retail at an additional cost? etc.)
Pet 2 Is there anything we should know about your pet’s behaviour?*
(ie. Anxiety, Aggression, Energetic, etc.)
Pet 3 Is there anything we should know about your pet’s behaviour?*
(ie. Anxiety, Aggression, Energetic, etc.)
Pet 4 Is there anything we should know about your pet’s behaviour?*
(ie. Anxiety, Aggression, Energetic, etc.)
Pet 2 Has your pet ever bitten anyone? If yes, when?*
Pet 3 Has your pet ever bitten anyone? If yes, when?*
Pet 4 Has your pet ever bitten anyone? If yes, when?*
Pet 2 Does your pet have any medical conditions we should be aware of?*
(ie. Diabetic, Epileptic, etc.)
Pet 3 Does your pet have any medical conditions we should be aware of?*
(ie. Diabetic, Epileptic, etc.)
Pet 4 Does your pet have any medical conditions we should be aware of?*
(ie. Diabetic, Epileptic, etc.)
Pet 2 Does your pet require any medications? If yes, please list medication(s) and when they are given?*
(Please note that we always check for fleas on admission, if we find any signs of fleas on your pet, they will be treated at the owner’s expense).
Please note that the cost will be $36 per day if your pet requires medication administered by a technician only (any kennel size) Ex. injections
Pet 3 Does your pet require any medications? If yes, please list medication(s) and when they are given?*
(Please note that we always check for fleas on admission, if we find any signs of fleas on your pet, they will be treated at the owner’s expense).
Please note that the cost will be $36 per day if your pet requires medication administered by a technician only (any kennel size) Ex. injections
Pet 4 Does your pet require any medications? If yes, please list medication(s) and when they are given?*
(Please note that we always check for fleas on admission, if we find any signs of fleas on your pet, they will be treated at the owner’s expense).
Please note that the cost will be $36 per day if your pet requires medication administered by a technician only (any kennel size) Ex. injections
Pet 2 Would you like to have any of the following extras done at an additional cost?* Pet 3 Would you like to have any of the following extras done at an additional cost?* Pet 4 Would you like to have any of the following extras done at an additional cost?* Pet 2 If you selected Extra Play time or Brushing Please Enter How Many Days you would like this service:
Pet 3 If you selected Extra Play time or Brushing Please Enter How Many Days you would like this service:
Pet 4 If you selected Extra Play time or Brushing Please Enter How Many Days you would like this service:
Information For 5 Pets Pet 2 Pet's name*
Pet 3 Pet's name*
Pet 4 Pet's name*
Pet 5 Pet's name*
Pet 2 Feeding Instructions*
(ie. 1 cup of kibble twice daily)
Pet 3 Feeding Instructions*
(ie. 1 cup of kibble twice daily)
Pet 4 Feeding Instructions*
(ie. 1 cup of kibble twice daily)
Pet 5 Feeding Instructions*
(ie. 1 cup of kibble twice daily)
Pet 2 Does your pet have any food allergies?*
Pet 3 Does your pet have any food allergies?*
Pet 4 Does your pet have any food allergies?*
Pet 5 Does your pet have any food allergies?*
Pet 2 Should your pet refuse to eat, which diet alternative do you prefer?*
( Soak kibble? Another food from our retail at an additional cost? etc.)
Pet 3 Should your pet refuse to eat, which diet alternative do you prefer?*
( Soak kibble? Another food from our retail at an additional cost? etc.)
Pet 4 Should your pet refuse to eat, which diet alternative do you prefer?*
( Soak kibble? Another food from our retail at an additional cost? etc.)
Pet 5 Should your pet refuse to eat, which diet alternative do you prefer?*
( Soak kibble? Another food from our retail at an additional cost? etc.)
Pet 2 Is there anything we should know about your pet’s behaviour?*
(ie. Anxiety, Aggression, Energetic, etc.)
Pet 3 Is there anything we should know about your pet’s behaviour?*
(ie. Anxiety, Aggression, Energetic, etc.)
Pet 4 Is there anything we should know about your pet’s behaviour?*
(ie. Anxiety, Aggression, Energetic, etc.)
Pet 5 Is there anything we should know about your pet’s behaviour?*
(ie. Anxiety, Aggression, Energetic, etc.)
Pet 2 Has your pet ever bitten anyone? If yes, when?*
Pet 3 Has your pet ever bitten anyone? If yes, when?*
Pet 4 Has your pet ever bitten anyone? If yes, when?*
Pet 5 Has your pet ever bitten anyone? If yes, when?*
Pet 2 Does your pet have any medical conditions we should be aware of?*
(ie. Diabetic, Epileptic, etc.)
Pet 3 Does your pet have any medical conditions we should be aware of?*
(ie. Diabetic, Epileptic, etc.)
Pet 4 Does your pet have any medical conditions we should be aware of?*
(ie. Diabetic, Epileptic, etc.)
Pet 5 Does your pet have any medical conditions we should be aware of?*
(ie. Diabetic, Epileptic, etc.)
Pet 2 Does your pet require any medications? If yes, please list medication(s) and when they are given?*
(Please note that we always check for fleas on admission, if we find any signs of fleas on your pet, they will be treated at the owner’s expense).
Please note that the cost will be $36 per day if your pet requires medication administered by a technician only (any kennel size) Ex. injections
Pet 3 Does your pet require any medications? If yes, please list medication(s) and when they are given?*
(Please note that we always check for fleas on admission, if we find any signs of fleas on your pet, they will be treated at the owner’s expense).
Please note that the cost will be $36 per day if your pet requires medication administered by a technician only (any kennel size) Ex. injections
Pet 4 Does your pet require any medications? If yes, please list medication(s) and when they are given?*
(Please note that we always check for fleas on admission, if we find any signs of fleas on your pet, they will be treated at the owner’s expense).
Please note that the cost will be $36 per day if your pet requires medication administered by a technician only (any kennel size) Ex. injections
Pet 5 Does your pet require any medications? If yes, please list medication(s) and when they are given?*
(Please note that we always check for fleas on admission, if we find any signs of fleas on your pet, they will be treated at the owner’s expense).
Please note that the cost will be $36 per day if your pet requires medication administered by a technician only (any kennel size) Ex. injections
Pet 2 Would you like to have any of the following extras done at an additional cost?* Pet 3 Would you like to have any of the following extras done at an additional cost?* Pet 4 Would you like to have any of the following extras done at an additional cost?* Pet 5 Would you like to have any of the following extras done at an additional cost?* Pet 2 If you selected Brushing Please Enter How Many Days you would like this service:
Pet 2 If you selected Extra Play time Please Enter How Many Days you would like this service:
Pet 3 If you selected Extra Play time Please Enter How Many Days you would like this service:
Pet 3 If you selected Brushing Please Enter How Many Days you would like this service:
Pet 4 If you selected Extra Play time Please Enter How Many Days you would like this service:
Pet 4 If you selected Brushing Please Enter How Many Days you would like this service:
Pet 5 If you selected Extra Play time Please Enter How Many Days you would like this service:
Pet 5 If you selected Brushing Please Enter How Many Days you would like this service:
Additional Information Primary phone number of an emergency contact that can be reached at all times during your pet's stay, and who it belongs to?*
Who primary phone number belongs to*
First
Last
Alternative phone/email address*
Who alternative phone number/email address belongs to*
First
Last
I am the owner/representative of the above mentioned pet. I am 18 years of age or older and I have the authority to give consent. I have agreed to the above procedures and related clinic fees. I understand that a deposit may be required and the entire balance is due when the pet is picked up. I also under stand that unforeseen conditions may be revealed during my pets stay, in which my pet may require different treatments or procedures. I
understand that reasonable efforts will be made to contact me to explain these procedures and treatments, and to obtain my instructions
regarding them. If efforts are unsuccessful, I authorize the performance of any procedures or treatments which are necessary in the
professional opinion of the veterinarian.
We take all precautions within our boarding facility. We require all pets to be completely vaccinated prior to being admitting. Since immunity varies with
the circumstances, and the pets overall health, no vaccine is 100% there are minimal risks due to the fact we are a hospital and viruses can be present
and your pet may be exposed. Some pets become stressed which can result in diarrhea. I have been made aware of these risks,I authorize the
performance of any procedures or treatments which are necessary in the professional opinion of the veterinarian.
If my pet is found to have fleas and/or ticks, they will be treated at the owners expense.
Should the circumstances arise that my pet(s) remains unclaimed after the date stated as the pick-up date, I understand that written notice will be mailed to the address on file. Seven days after such notice, the pet(s) will be considered abandoned and may be surrendered to a different facility. It is further understood that such action will not relieve me from paying all costs of services.
1. All vaccinations must be up to date including Kennel cough vaccination. A proof of vaccinations in the form of a certificate is required for non clients.14. At time of drop-off the receptionist will go over your form and have you sign an estimate. Your Name*
Date*
