Prairie Ridge Animal Hospital
Boarding Admission Form
Check out time is before 11:00 am the day of pick up. If picked up after 11:00 am, you will be charged an additional day of boarding. Drop off can be anytime between 7:30am-5:30pm Monday through Friday and 9am-12pm on Saturday. There is no Sunday drop-off or pick-up.
Client Name: ______Pet Name:______
Check-in Date: ______Pick-Up Date: ______Pick-Up Time (AM or PM):______
Nail trim: ($18) Yes___ No___ Complimentary Bath: Yes___ No___
Emergency Contact: Name (s) ______
Emergency Contact Phone Number(s) ______
HAVE YOU NOTICED YOUR DOG COUGHING? Yes___ No___
Does <animal> need medication while staying with us? Yes___ No___
(There will be a $4.00 per day charge for pets requiring medication during their stay)
Instructions: ______
______
Food: Kennel___ Own___ Did <animal> eat before drop off? Yes______No______
Instructions (how much/ how often): ______
Did you bring any boarding items with <animal>: Yes___ No___
Description of Items in detail: Leash: Collar: Other:
Please indicate if you would like your dog to play with other boarding dogs. Please note that by signing this form you are releasing Prairie Ridge Animal Hospital of any responsibility or liability for any accident or injury that occurs while playing with other pets. You will be liable for any accrued medical charges for your pet.
Yes ____
No_____
Is your pet spayed or neutered? (If your dog is over the age of 6 months and not neutered or if your female dog is in heat they cannot play with other boarding dogs).
Yes ____
No_____
Would you like text/email pictures of your pet(s) during their stay? Pictures will not be sent outside of regular business hours.
Yes _____
No _____
What phone number or email would you like for us to use?
1) For the protection of all our boarding guests, your dog must be current on vaccinations, Distemper, Parvo virus, Leptospirosis, Rabies, and bi-annual Bordetella, annual heartworm test and bi-annual fecal exam with giardia for dogs. Distemper, Rhinotracheitis, Corona, Leukemia, Rabies, FIV/FeLV test, and bi-annual fecal exam required for cats. A licensed Veterinarian MUST have given these vaccines. Without proof of current vaccines, Prairie Ridge Animal Hospital will perform an exam and administer the required vaccines and the appropriate fees will be charged. All animals admitted must be free of all external parasites. ANY ANIMALS FOUND TO HAVE TICKS, FLEAS, MITES, WORMS, AND GIARDIA WILL BE TREATED AT OWNER’S EXPENSE. Pets found to have contagious diseases will be isolated from other pets. I will not hold Prairie Ridge Animal Hospital responsible or liable for any accident or injury that occurs while boarding. I understand that my pets and I may be videotaped, or photographed. Prairie Ridge Animal Hospital will retain exclusive rights to images.
PERMISSION TO TREAT-
I am the owner (or agent of the owner) of the pet listed above. I understand that Prairie Ridge Animal Hospital will use reasonable precautions to assure my pets safety while in their care. I authorize the doctors and staff to provide any treatment deemed necessary, and will assume responsibility for any treatment expenses involved.
Owners/Agents Signature______Date______