Boarding Release Form Boarding Release Form Boarding Release Form Name * Name First First Last Last Email * Pet's Name * For general or emergency contact purposes, please choose the preferred method of contacting you, or an authorized representative, while your pet is boarding. Call specified phone number Text cell phone Email DEPENDING ON YOUR PREFERENCE ON HOW YOU WANT TO BE CONTACTED WHILE YOUR PET IS BOARDING - please provide either the phone number for us to call, or a cell number that we can text you on, or an email address. If we are to contact an authorized representative while you are away, please provide their name. Boarding reservations are recommended to ensure space is available. Have you already made the boarding reservation? * Yes No Is this currently a patient of The Village Vets? * Yes No If not, please provide the name and phone number of the vet clinic that has the current vaccine history for this pet. * Boarding Entry Date (Dropping Off) * Boarding Exit Date (Picking Up) * Would you like for your pet to have a bath before he or she is picked up from boarding * Yes No If you did choose a bath for your pet, what time approximately will you be picking your pet up (i.e. before noon or after noon), so that can determine if your pet should be bathed the day before or the morning of the day you are picking up. Medication: If your pet is on medication, please list those medications and dosing instructions for each. Prescription medication should be in the bottles the medicines were originally dispensed in. Feeding instructions: Please describe your pet's eating schedule and amount, i.e. feed once a day, twice a day etc. Give the amount to be fed at each meal, i.e. number of cups, cans etc. If a combination of food is to be given, i.e. dry food is to be given, i.e. dry food and canned food, please detail those instructions. * Medical Services/Treatments to be provided while boarding Boarding Agreement Please note: The Village Vets is not responsible for clients/pets personal items (leashes/collars/toys/bedding) that are left during their pet’s visit. In case of illness or injury, I, the undersigned, do hereby give my authorization and consent for the doctors of the hospital to treat any illness and/or injury of my pet(s) while they are being boarded at The Village Vets. I also understand that these services performed on my pet(s) during The Village Vets Decatur’s afterhours will be charged the same fees as Emergency After-Hours. They are to use all responsible precautions against illness, injury, or escape of my pet(s), but they will not be held liable or responsible in any manner whatsoever, under any circumstances, on account of the care, treatment, or safe keeping of my pet(s), as it is thoroughly understood that I assume all risks. Should the circumstances arise that my pet(s) remain unclaimed after the date which I have stated as the pick-up date, I understand that written notice will be mailed to my current address. Seven days after such written notice the pet(s) will be considered abandoned and may be disposed of, or destroyed, as the hospital deems best. It is further understood that such action will not relieve me from paying all costs of the services, including the cost of the boarding service. The Village Vets promotes a flea and tick free environment. If fleas and/or ticks are noted on your pet(s) upon arrival or while here, a preventative will be applied to your pet immediately, and the charge for the preventative will be added to your bill. My pet has been fully vaccinated within the past 12 months. If I cannot show proof of such vaccinations, then I give permission for the hospital to administer vaccinations required for the boarding of my pet(s). With annual vaccines your pet will be examined by a veterinarian and subsequent fees will apply. For cat boarding, a FeLV/FIV test must have been done within the year for outdoor cats and within three years for inside cats. For dog boarding, a fecal exam must have been done within the year and proof provided, along with proof of vaccines. I have read and understand the authorization and consent. * I consent Signature * signature keyboard Clear Date * Captcha Submit If you are human, leave this field blank.
