BOARDING FORM

Owner Name

Mobile Number *

Email Address *

Address

City, State, Zip Code

Referred By

Emergency Contact

Veterinary Clinic Name

Veterinary Clinic Phone

Veterinary City, State

Flea & Tick Prevention: Product Name

Flea & Tick Prevention: Date Last Administered

Pet Name

Pet Breed

Pet DOB/Age

Pet Color

Pet Sex; Spayed/Neutered?

Failing Vision

Failing Hearing

Chronic Illnesses or Medical Condition?

Allergies?

Special Rules or Behavior Quirks?

Is Your Dog Aggressive with People or Other Dogs?

Protective of Food?

Has Your Dog Ever Bitten A Person Or Other Dog?

Does Your Dog Socialize With Other Dogs? Where and How Often?

BOARDING INSTRUCTIONS: Share Kennel With Housemate; No Food Dominance or Eating Housemate's Food

BOARDING INSTRUCTIONS: Board Alone; Allow to Play Outside With Appropriate Companion

BOARDING INSTRUCTIONS: Board Alone, Outside Alone

EMERGENCY VETERINARY CARE DIRECTIVE: If my pet becomes seriously ill and I cannot be reached, follow these instructions for veterinary care:

Pursue any diagnostic tests and extraordinary measures offered by the treating veterinarian
As long as my pet is likely to recover its previous quality of life, pursue any diagnostic tests and extraordinary measures by the treating veterinarian
I do not want extensive diagnostic tests or any extraordinary measures taken

PET PLACE LODGING – BOARDING AGREEMENT Pet Place Lodging – Boarding Agreement All the pets are boarded at Pet Place Lodging without liability for loss of your pet due to illness, injury, death, theft, fire, or other unavoidable causes. You, the pet owner, are responsible for all costs for any property damage or personal injury to other pets during its stay. All charges for boarding, grooming, other services, and damages are payable upon departure of your pet. Should your pet become ill or injured, you shall be notified at once if possible. I, Michelle Ahrendsen, reserve the right to obtain information, advice, and medical attention from a veterinarian of my choice, concerning your pet. Any incurred vet charges are to be paid by you, the pet owner, upon your pet’s departure from Pet Place Lodging. As a condition of this agreement, you authorize the release of your pet’s vaccination and medical information to Pet Place Lodging at any time prior to, during, or after the performance of services. You, the pet owner, also authorize Michelle Ahrendsen to make medical/surgical decisions for your pet, on your behalf, if you cannot be reached immediately and your pet’s condition is time sensitive. Your wishes, under the Emergency Veterinary Care Directive section of your intake form, will be followed if you cannot be reached immediately. This agreement shall be in effect each time the pet owner requires the services of Pet Place Lodging for this pet and any other future pet owned by the signee of this agreement. Owner Signature

Date