Cypress Animal Hospital, Inc

Cypress Animal Hospital, Inc.

Boarding Information/Agreement Form

Client's Name:

DATES: Dropping Off______Picking Up______Time?______

Emergency Contact and Numbers (MUST be someone local):

Pet(s) Boarding: ______

**We require all pets be up to date on necessary vaccinations in order to stay at the clinic. Pleasepresent proof of vaccination if done elsewhere. These vaccinations include: Cats - Feline Distemper and Rabies Dogs - Distemper, Parvo, Corona, Bordetella (Kennel Cough) and Rabies

I accept this policy and agree to have my pet(s)'s vaccines updated if needed. Please initial

Does pet(s) require any MEDICATIONS or TREATMENTS while boarding?______

Please list with instructions:______

Please list any allergies to medicine or vaccines: ______

NOTE: THERE WILL BE A DAILY FEE CHARGED FOR ABOVE SERVICE IN ADDITION TO BOARDING FEE. Please Initial ______

Will HEARTWORM PREVENTION need to be given while boarding? When?______

Does the Doctor need to EXAMINE pet(s) while boarding? Reason?______

DIET to be fed: Clinic (Purina)______Brought from home______Other______

Treats brought:______; Toys/bedding/carrier brought:______

Do you want your pet(s) to have: a BATH prior to pick up? ______

Topical flea medication?______Which type?______Nail trim?

**Because of the many pets that come through the clinic, we strive to keep FLEAS and TICKS
under control. As a result, any pet staying at the clinic found to have many fleas or any ticks will be
treated with the lowest priced topical flea medication upon entering at the owner's expense. Please
initial for acceptance of this policy. Please Initial:______

I fully understand that I assume all risk and that the clinic and staff will not be held liable for any problems that develop provided that they have taken all reasonable precautions against injury, escape or death of my pet(s). I understand that if any problems occur, the doctor will attempt to contact me and/or the emergency contact listed above. If neither can be contacted, my pet will be treated as deemed necessary by the doctor, and I assume full responsibility for all resulting treatment expenses. I fully intend to pick up my pet(s) on the date that I have stated. I will call to inform the clinic of a new pick up date if circumstances change. If I do not pick up my pet(s) within 7 days of the stated date and do not call to change this date, my pet(s) will be considered abandoned. I have read and understand this entire agreement.

Signature:______

C:\Documents and Settings\Reception\My Documents\boarding Agreement.docx