Requested Reservation Dates:

Drop-Off Date & Time: *

Date

Time

Pick-Up Date & Time: *

Date

Time

Owner's Name *

First

Last

Email *

Phone where you can be reached (in case of emergency): *

Local Emergency Contact (name & phone): *

Is this person authorized to make medical decisions in your absence? *

Yes
No

Pet Name: *

Pet Species: *

Dog
Cat

Does your pet require specific medical care while here? If so, please describe:

Please read the following carefully:

Health & Vaccination Requirements: Thank you for choosing Avenue of the Saints Animal Hospital to care for your pet(s) while you are away. We are a Veterinary Clinic first and foremost, so in order to protect your pet(s) during their stay, we require them to be fully vaccinated for the following:

DOGS: Must have Rabies, Distemper/Parvo & Bordetella Vaccines. Proof of vaccination must be provided no less that 24 hours prior to reservation, please note that your reservation may be forfeited without proper advance information. *

I understand and accept

CATS: Must Have Rabies & Distemper (FVRCP) Vaccines, & Negative FELV/FIV Test. Proof of vaccination must be provided no less that 24 hours prior to reservation, please note that your reservation may be forfeited without proper advance information. *

I understand and accept

Pet must be free of internal and external parasites / Negative Intestinal Parasite Screening (Stool Sample every 12 months). Please provide the Prevention given and what date it was administered. *

If my pet is found to have Fleas, Ticks or other parasites, immediate treatment will be administered at my expense. *

I understand and accept

Medical Care Authorization: In the event my pet becomes ill, injured or requires veterinary attention while boarding and we are unable to contact you: *

I authorize the veterinarians at Ave of the Saints Animal Hospital to provide any medical care deemed necessary (emergency medical care could range, but not limited to $500-$2,000).
I authorize up to $500 without additional consent.

( I understand that I am financially responsible for all medical care provided.)

Feeding & Personal Belongings: We welcome you to bring your own food in labeled & portioned containers, however if you prefer, we will provide your pet with Hills Science Diet Sensitive Stomach & Skin dry food. We provide your pet with blankets, towels, treats bowls, etc. during their stay. We welcome you to bring your own creature comforts, but some pets have different behaviors while boarding than at home, including a change in bathroom habits or destruction of toys or blankets. They don't mean to behave this way; they just might miss you. If you choose to bring personal items, Ave of the Saints Animal Hospital will not be held responsible for the loss or destruction of items left. *

I understand and accept

Please tell us about your pet's feeding habits so we can help them feel more "at home":

(#1) Name of Food/Treat:

(#1) Dose (how much):

(#1) Frequency (how often):

(#1) When is next meal due?

(#2) Name of Food/Treat:

(#2) Dose (how much):

(#2) Frequency (how often):

(#2) When is next meal due?

(#3) Name of Food/Treat:

(#3) Dose (how much):

(#3) Frequency (how often):

(#3) When is next meal due?

Are you leaving any personal belongings, if so, describe? (toys/blanket) *

Does your pet have any food allergies or sensitivities? If so, describe: *

Medications: Please list name/date and frequency of all medications your pet is receiving. ALL medications must be in original pill container with clear and correct instructions.

here? have must

(#1) Name & Strength:

(#1) Dose (how much):

(#1) Frequency (how often):

(#1) When is next dosedue?

(#2) Name & Strength:

(#2) Dose (how much):

(#2) Frequency (how often):

(#2) When is next dose due?

(#3) Name & Strength:

(#3) Dose (how much):

(#3) Frequency (how often):

(#3) When is next dose due?

Special Instructions:

Risks of Boarding: I understand that boarding can carry risks including stress, exposure to infectious disease or injury. Avenue of the Saints Animal Hospital will take all reasonable precautions, but I release the hospital & staff from liability for illness, injury, escape, or death of my pet, except in case of proven negligence. *

I understand and accept

Notice: Personnel are not on the premises at night or outside of business hours.

Pickup & Payment Policy: I agree to pick up my pet on the scheduled date. If I cannot, I will notify the hospital. I understand that pets not picked up within 7 days of the scheduled release date may be considered abandoned and appropriate action may be taken as allowed by law. *

I understand and accept

All boarding and medical charges are due at time of pick up.

Acknowledgement: By signing below, I certify that I am the legal owner/agent for the above pet, and I have read, understood, and agree to the terms of this consent form. *

Clear Signature

Date *

Charles City

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Boarding Agreement Form

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Please read the following carefully:

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