CLIENT INFORMATION

Owner Name *

Co-Owner / Spouse Name

Emergency Phone Number #1 *

Emergency Phone Number #2

Address *

City *

State *

Zip Code *

Email Address *

Note: At your first appointment at our hospital, we may ask to collect your driver's license and social security number for payment collection purposes. We may also require a photocopy of your license.

PET INFORMATION

Pet's Name *

Type of Animal *

Dog

Cat

Other (specify in the next box)

If Other, list type of pet:

Sex *

Male

Female

Spayed / Neutered *

Yes

No

If more than one pet is being boarded, indicate other pet name(s) below.

Note: Please fill out a separate form for each pet.

BOARDING SERVICES

Would you like your pet bathed while boarding? *

Yes

No

Note: I understand that if my pet soils themselves, they will receive a clean up bath at a cost to me (price depends on size of pet) *

I agree.

Are any medications necessary while boarding? *

Yes

No

All medications MUST be in the original bottle.

If medication is required, please include the names and instructions below.

Are you bringing your own food? *

Yes

No

How many feedings per day? *

AM

NOON

PM

How much per feeding? *

Special feeding instructions, if applicable.

PLAYGROUND RELEASE

While my dog(s) are boarding and/or hospitalized, I authorize permission for them to be walked off-leash in your secured, supervised playground area. *

I give permission.

I do not give permission.

List pet(s) allowed to walk/play together, if applicable.

OWNER RELEASE

I confirm that all vaccinations must be current and up-to-date and will provide proof. *

Yes, my pet has current vaccinations.

I confirm that my pet(s) are free of external parasites (ex. ticks, fleas, etc.). Animals will be checked for fleas upon admission. If fleas are found, your pet will be given a Capstar at the owner's expense. *

Yes, my pet is parasite-free.

I agree that Thomasville Veterinary Hospital Urgent Care + Surgery/Thomasville Pet Resort has my permission to do whatever is deemed necessary should an emergency arise. *

Yes, I agree.

I give permission for my pet(s) to have their toys and/or personal belongings with them in their kennel. I understand this is not the recommendation of Thomasville Veterinary Hospital Urgent Care + Surgery/Thomasville Pet Resort. I understand Thomasville Veterinary Hospital Urgent Care + Surgery/Thomasville Pet Resort will not be held liable for any damage or injury that may result from unsupervised access to these items, and is not responsible for any lost or damaged items. *

I give permission for my pet to have their own toys during their boarding stay.

I will not be leaving any toys for my pet during their stay.

Please, list all belongings being left with your pet:

I give permission for my pets to board together in the same kennel, if applicable. I understand that this is not the recommendation of Thomasville Veterinary Hospital Urgent Care + Surgery/Thomasville Pet Resort. I hereby release Thomasville Veterinary Hospital Urgent Care + Surgery/Thomasville Pet Resort of any responsibility in the event my pets may become injured due to boarding together. *

Doesn't apply.

I give permission for my pets to board in the same kennel.

I want my pets to board in separate kennels.

I authorize Thomasville Veterinary Hospital Urgent Care + Surgery/Thomasville Pet Resort to use all reasonable precaution against injury, escape, or emergency with my pet. The clinic and staff will NOT be held liable for any problems that develop, provided reasonable care and precautions are followed. I understand that ANY problem that develops with my pet while I'm absent will be treated as deemed best by the staff veterinarians, and I ASSUME FULL RESPONSIBILITY for the treatment expense involved. If I neglect to pick up my pet with in 5 days of the date below and do not notify you within that time frame, you may assume that my pet is abandoned and you are hereby authorized to handle the pet as you deem best and/or necessary. *

Yes, I understand and agree to these terms.

Please note:

Pets may be picked up between 10:00am - 5:30pm Monday through Friday, and 10:00am - 12:30pm on Saturday.

As a flea-free hospital, we are no longer able to accept your pet's bedding. This is to protect your pet(s) from external parasites. We will provide bedding for your pet(s), that are changed daily or whenever soiled. We apologize for any inconvenience this may cause.

I have read the boarding form and understand the hospital's policies. *

Yes, I understand and agree to these terms.

Date *

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Boarding Registration Form