Boarding Information Form







Vaccination Due Dates
DHPP DHP
Parvo Bordetella Rabies
FVRCP FELV TEST (<1YR) / FELV VX (<3 YRS):


Emergency Contact Numbers
Name Number
Name Number
My emergency contact is authorized to make decisions on my behalf. (owner signature)


Pet Belongings
Check In Check Out

Please remember that we cannot insure the safe return of any item left while boarding at our facility.

Special Instructions Medical Contitions
Medications YesNo
If yes, you will need to complete a medications sheet when checking in your pet.


Feeding Instructions
Own Food Brand
YesNo
Quantity Times/Day
My pet has already been fed today Special Instructions
YesNo


Playtime

(If your pet is older than 6 months, they must be neutered to enjoy playtime)

Does your dog play well with others? If so, would you like your pet to have playtime with other animals?
YesNo YesNo
Playtime will be based on the boarding supervisor’s opinion. Only dogs with compatible temperaments will be permitted to play together, and the boarding staff will accompany them at all times.


Estimated Expenses
Boarding Daily Medication Insulin Bath
Exam DHPP Bordetella Rabies
FVRCP FELV Flea/Tick Prevention Other
Boarding Staff Checking In


Authorization For Medical Treatment
If your pet becomes ill or injured, or if the state of your pet’s health otherwise requires professional attention, AMSC will make a reasonable attempt to contact you (the owner), but in its sole discretion, may provide veterinary services, and the expenses thereof shall be paid by the Owner. I authorize Animal Medical & Surgical Center to treat in the best interest of my pet, for medical conditions that may arise, and the associated charges.
Owner Signature


Refusal of Medical Treatment
In the event that my pet becomes ill or injured, or if the state of my pet’s health otherwise requires professional attention, I DO NOT authorize AMSC to provide veterinary services. If any adverse medical problems occur because of my decision to refuse veterinary services, I accept full financial and
medical responsibility for my decision, and I release the staff at this veterinary practice of all responsibility for my decision.I understand the medical risks for my pet and that those risks may include death.
Owner Signature

• All pets must be current on their vaccinations. If we do not serve the veterinary needs of your pet at our facility, please provide us with records of your pet’s vaccination
history.
• Your pet will be treated for external parasites upon entrance at an additional charge, if needed, as not to contaminate this facility or the other pets staying here.
• It may be necessary to temporarily move your pet from their assigned run or cage in order to maintain a clean and sanitary environment.
• I understand my pet may require light sedation if he or she becomes overly stressed or anxious while boarding.
• WE WILL NOT RELEASE PETS AFTER BUSINESS HOURS OR ON HOLIDAYS.

Signature