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Owner's Name: ________________________________
Address: _____________________________________
City:________________________________ State:____________ Zip:________
Email: _______________________________________
Home #:_________________ Work #: _________________Cell #:________________
Veterinarian:______________________________ Phone #:_____________________
Who can act on your behalf if need be?
Name:_______________________
Day #:______________________ Evening #:_______________________
Pet Information
Pet Name: _____________________ Male ___ Female ___
Neutered_____Spayed? _____
DOB /AGE___________
Breed:___________________ Color: _____________Weight: ________________
PRESENT HEALTH CONCERNS AND PERTINENT MEDICAL HISTORY:
________________________________________________________________________
________________________________________________________________________Please give us a general idea of a typical meal that your pet is used to. (We feed at 7 am and 5 pm)
AM / Amount/ Dry/ Wet _______________________________________________
Mid-Day / Amount/ Dry/Wet ____________________________________________
PM / Amount/ Dry/Wet ________________________________________________
Medications: Prescription & Non- Prescription
AM / Dose /Medication _______________________________________________
Mid-Day / Dose/ Medication____________________________________________
PM / Dose/ Medication________________________________________________
Vaccinations and Inoculations
We require a Veterinary Certificate showing current vaccinations for all pets entering the facility. All inoculations or booster shots must have been given at least 7 days prior to boarding. Please bring a copy of your vet records.
Flea and tick preventative: Yes/ No Brand___________________________
Please list any pertinent information you feel is important concerning your Pet:
Terms
I agree to exercise due and reasonable care and to keep my kennel premises sanitary and property enclosed. The pet is to be fed properly and regularly, and to be housed in clean, safe quarters.
All pets are boarded or trained, or otherwise cared for by me without liability on my part for loss or damage from disease, death, running away, theft, fire, injury to persons, other pets, or property by said pet, or other unavoidable causes, due to diligence and care having been exercised.
If a pet, which is presented for boarding, is found to have fleas and/or ticks, it will be bathed at the owner’s expense.
The pet is not to be taken off the premises except by the consent of the owner.
If the pet becomes seriously ill, the owner shall be notified at once in cases where no particularveterinarian has been designated. If the owner does not inform immediately regarding measures to be taken, or if the state of the pet’s health reasonably demands quick action, I shall have the right to call a veterinarian, as designated above or if no veterinarian is designated, to call a veterinarian of my choice or take the pet to said veterinarian in either case; or administer medicine or give other advisable attention, within my discretion and judgment, and such expenses, being reasonable in amount shall be paid promptly by the owner of the pet.
If any charges for boarding, grooming, training, medicine, or veterinary services are not paid within ten days after they are due, or if pet is not called for within ten days after time for return of pet, the pet will be sold within ten days after this period by me publicly, privately, or otherwise for the best price available. Notice in writing of such intended sale shall be mailed by registered mail to the owner of the pet at the address given hereon, of less than ten days before date of such intended sale, and no further notice shall be deemed necessary. Any excess amount over charges will be given to the owner, any deficiency is deemed to be due and immediately paid by the owner.
I hereby agree to the foregoing as owner of the pet.
Owner Name: (Signature) ________________________________________________________
Kennel Representative: __________________________________________________________