Pet Name Client Name Client Phone(Home)Client Phone(Cell)Client Phone(Work)Email Arrival Date MM slash DD slash YYYY Departure Date MM slash DD slash YYYY Please note our last pick up on departure day is 4:40 PM on Mondays, Tuesdays, Thursdays and Fridays and on Wednesdays pick up is at 1:40.Your pet must be current on all recommended vaccinations before boarding at our facility. The client acknowledges that they are placing the pets into an area in which communicable diseases may pass between seemingly healthy pets. If following a provided service date the pet shows signs of illness, the client may not hold Rainsville Animal Clinic liable for any inadvertent exposure the pet may have received, and if the client requests an exam, treatment, or medications for the pet that it will be provided by Rainsville Animal Clinic at full cost to the client. If proof of vaccination can be provided for each pet, no additional vaccines will be administered. If such proof cannot be provided, a Rainsville Animal Clinic veterinarian will administer all required vaccines at the owner’s expense. Vaccines that have been administered by a non-veterinarian will not be accepted.Vaccinations Required include: Adult Cats: Must be current on Rabies and FVRCP+ FeLK Adult Dogs: Must be current on Rabies, DAPPvL and Bordatella (at least 10 days prior) Kittens: At 8 weeks FVRCP+FeLK and at 12 weeks FVRCP+FeLK and Rabies Puppies: At 6 weeks DAPPv, at 8 weeks DAPPvL and Bordatella, and at 12 weeks DAPPvL and Rabies Rainsville Animal Clinic is a flea free environment. If we notice fleas on your pet we will give a Capstar pill. Capstar cost around $6 and is extremely safe. This is to protect your pet as well as others in our facility. If your pet needs to receive daily medications while boarding there will be additional $2.00 charge per day. Clear and concise instructions must be provided. Please ensure that all items are labeled with name and dosing instructions that match the instructions written below. If items are given only once daily, please indicate AM or PM dosing.Med Dosing Instructions Med Dosing Instructions Med Dosing Instructions Items Brought: Rainsville Animal Clinic provides bedding to all pets during stay free of charge. Please bring only small blankets or other items to remind pet of home. Label items with permanent marker and describe items brought. No guarantee can be made against loss or damage to items left with pet during boarding stay. Any items which are unlabeled and unclaimed may be donated to the facility. Please list items brought Please answer the following questions so that we may better individualize your pet’s needs: Will Science Diet Adult Maintenance dry formula be sufficient for feeding? Yes No If no please provide food and instructions Name of person picking up this pet on departure other than client(s) named on this account (ID must be shown at time of departure Alternate Emergency Contact Name and Numbers Please Initial Below I acknowledge that Rainsville Animal Clinic is “flea free” facility and in order to maintain this, if we see fleas on your pet a single Capstar tablet to kill any live fleas will be charged to the account. If ticks are found, an additional treatment will be administered at the owner’s expense. I acknowledge that proof of vaccinations that meet the standards for sufficient protection in a commingled environment are required. If proof is not provided doctors of Rainsville Animal Clinic will administer necessary vaccines at owner’s expense. I acknowledge that should the pet remain unclaimed after the scheduled departure date as designated on this form signed at the beginning of each boarding stat and Rainsville Animal Clinic has been unsuccessful in reaching the client regarding further instructions, the pet shall be considered abandoned. Laws concerning abandonment of pets at veterinary facilities will govern Rainsville Animal Clinic’s course of action theretofore. The client acknowledges that such action on Rainsville Animal Clinic’s part does not release the client of financial responsibilities for boarding or other services provided during the pet’s boarding stay. I acknowledge that Rainsville Animal Clinic will use all reasonable precaution against injury, escape, complications and death. I agree not to hold the doctor, staff or corporation responsible under any circumstances. I acknowledge that Rainsville Animal Clinic will attempt to contact me in the event that the unexpected medical attention is deemed necessary by the medical staff. If Rainsville Animal Clinic is unable to contact me, I grant permission to treat as follows: Treat minor issues (ear/skin/eye infections, diarrhea?) Yes No $_____maximum amount authorized or No treatment until I am reached Perform emergency procedure? Yes No $_____maximum amount authorized or No treatment until I am reached Cell PhoneWork PhoneHome PhonePrint Name SignatureDate MM slash DD slash YYYY
