Boarding Admission & Policy Form

Pet's Name*

Pet Breed & Color*

Owner’s Name:

First Last

Owner's Phone Number

Emergency Contact Name

First Last

Emergency Contact's Phone Number

Vaccination Policy

Vaccination Policy*

I understand that state law requires rabies vaccination for all pets.

FOR DOGS: I also understand clinic policy requires a yearly Distemper/Hepatitis/Leptospirosis/Parainfluenza/PaRvo vaccine and intranasal Bordetella (kennel Cough) vaccine for boarding dogs.
FOR CATS: I also understand clinic policy requires a yearly Rhinotracheitis/Calici/Panleukopenia/Chlamydia Psittaci, for all cats to board.

Consent/ Signature*

I understand that if my pet is not up to date on these vaccinations when coming to board, they will be vaccinated upon arrival. Furthermore, I understand that in order to maintain a flea-free environment, every animal that boards is also checked for fleas. I understand that if fleas are found on my pet, a flea eliminator will be administered for an additional charge.

Is your pet(s) on heartworm preventative?

Yes
No

If yes, when was the last dose given?

Is your pet(s) on flea prevention?

Yes
No

If yes, when was the last dose given?

Any vomiting, coughing, sneezing or diarrhea recently?*

Yes
No

If yes, please describe:

Special food or feeding instructions?*

Yes
No

If Yes, please describe

Any additional requests or instructions that would be helpful to the kennel staff?

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 owners/agent's expense.*

I consent

I understand that the clinic is to use all reasonable precautions against injury, escape, or death of my pet(s). The clinic and staff will not be held liable for any problems that develop provided reasonable care and precautions are followed. I understand in the event of my pet(s) illness, or other problems arise, 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.*

Please treat my pet(s) as required, you need not call me. In the event that sedation is necessary, I authorize the medical staff to sedate my pet(s) and/or perform such emergency procedures as may be necessary for the health of my pet(s) until I can be notified. I agree to pay, in full, all charges for necessary services rendered for and to my pet(s).
Perform only emergency and supportive care. Notify me for permission to begin any other treatment. I agree to pay, in full, all charges for necessary services rendered for and to my pet(s).
Do not evaluate any diagnostics and/or perform any treatments until I am notified and consent for you to evaluate and treat as recommended is given. This is to include the withholding of EMERGENCY services. I understand that by my election of this choice, that my pet(s) life may be jeopardized and that I hold Town and Country Veterinary Clinic along with any representative of the organization harmless.

Consent*

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, bedding, etc.

Consent*

I will call if my "pick-up date" changes so you can plan accordingly. If I neglect to pick up my pet(s) within 5 days of the date scheduled for discharge and do not notify you within that time period, you may assume that my pet(s) is considered abandoned.

Consent*

I understand there is an additional charge for any pet deemed aggressive during the boarding period.

Hurricane Policy

Due to the past events of hurricanes seasons, if your animal is boarding here in the event of a Hurricane, you are responsible for picking them up or have an emergency contact come pick them up. Our boarding facility is NOT approved to withstand hurricane conditions: therefore, we will NOT be taking animals in for evacuation. For the safety of our staff and your pets, please have an alternative plan during this season. In the event that you do not pick up your animal within 12 hours of the notification of the enactment of this Policy, the animal(s) will be considered abandoned.

Agreement & Acknowledgment

I hereby attest to the understanding and agreement to all the above policies and statements.*

I agree to the Boarding Policies Above.

Owners Name*

First Last

Today's Date:*

Vaccination Policy

Owner Release

Hurricane Policy

Agreement & Acknowledgment

Education, compassion, and complete care for you and your companion.

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