Boarding Agreement Form

Client Information

Owner's Name

Phone Number Emergency Phone Number
Street Address City, State Zip Code

Pet Information

Pet Name(s)

Breed Has your pet ever bitten anyone?
Age Gender Color

Authorization

This is an Agreement between Animal Medical & Surgical Center (hereinafter called “AMSC”) and the pet owner whose signature appears below (hereinafter called “Owner”).

1. Owner agrees to pay the rate for pet care provided in effect on the date pet is checked into AMSC. Owner further agrees to pay all costs and charges for special services requested, and all veterinary costs for the pet during the period said pet is in the care of AMSC. Owner further agrees that the pet shall not leave the facility until all charges due are paid by Owner or proper payment arrangements are agreed upon by both parties.

2. By signing this Agreement and leaving pet with AMSC, Owner certifies to the accuracy of all information given about said pet. Owner specifically represents that he or she is the sole owner of the pet, free and clear of all liens and encumbrances. AMSC reserves the right to deny admittance to Owner’s pet for any reason at any time.

3. While AMSC shall exercise reasonable care for the pet delivered by the Owner to the pet care provider, certain risks are inherent in any environment. Injuries may occur from routine activities such as running, jumping and playing, as well as contact with other pets. Owner recognizes and accepts the potential risks involved in these activities and agrees to indemnify and hold AMSC harmless, from and against all loss, damage or expense, including veterinary expenses and attorney’s fees, resulting from misrepresentations by you or your representatives or resulting from your pet’s stay including, without limitation, any person claiming damage or injury by your pet and any person claiming to be the owner of your pet. In addition, while all pets receiving services at AMSC are required to be current on distemper, parvo, rabies, and bordetella vaccines, it is still possible for a pet to become ill, even if they are current on their vaccinations. Such illness is not due to any circumstance or condition caused by AMSC and you agree that AMSC is not liable for any illness suffered by your pet(s) during or after his or her stay, including but not limited to Tracheobronchitis (Kennel Cough).

4. Owner specifically represents to AMSC that, to Owner’s knowledge, the pet has no behavior problem (including aggressive or biting behavior) that has not been disclosed to us, and has not been exposed to any contagious diseases within a thirty-day period prior to check-in. During the period of this Agreement, Owner also agrees to notify AMSC of any known exposure of pet to a communicable disease and hold pet out of attending AMSC until pet is symptom-free for a minimum of 14 days or with written veterinary clearance. Owner further agrees to maintain currency of vaccinations as required by AMSC policy. In addition, owner agrees to provide proof of preventative flea/tick treatment program and to be financially responsible for any required treatment for fleas/ticks, if determined necessary by the pet care provider. Rev: 4/08 © PCSA

5. AMSC is not responsible for loss or damage to any pet belongings, and reserves the right to refuse to accept items that may pose a danger to the pet.

6. If pet becomes ill or injured, or if the state of the animal’s health otherwise requires professional attention, AMSC will make a reasonable attempt to contact the owner, but in its sole discretion, may provide veterinary services, and the expenses thereof shall be paid by the Owner.

7. While AMSC has a nurse on duty 24 hours, pets will only be released for pick up during business hours.

8. This Agreement contains the entire agreement between the parties. All terms and conditions of this Agreement shall be binding on the heirs, administrators, personal representatives and assigns of the Owner and AMSC.

9. Any controversy or claim arising out of or relating to this Agreement, or the breach thereof, or as the result of any claim or controversy involving the alleged negligence by any party to this Agreement, shall be settled in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by an arbitrator may be entered in any Court having jurisdiction thereof. The arbitrator shall, as part of the award, determine an award to the prevailing party of the costs of such arbitration and reasonable attorney’s fees of the prevailing party.

By checking this box, I confirm that I have read and understand the agreement.

Owner Date

*This boarding agreement applies to all of your pets’ current and future visits to Animal Medical & Surgical Center