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For a tour of our boarding facilities, please feel free to drop by anytime.
To set up dates for boarding feel free to fill out the following form.
MARKET LANE ANIMAL HOSPITAL BOARDING CONSENT FORM
NAME: _____________________ ANIMAL’S NAME:_______________
ADDRESS: __________________________ BREED:____________
SPECIAL DIET: _______________ SEX: ___________
MEDICATIONS: _____________________ SPECIAL TOYS
COLLAR, LEASH, CARREIR, BLANKET...
TO: MARKET LANE ANIMAL HOSPITAL
I am the owner of the animal described herein or am the responsible for it and have the authority to execute this consent. I hereby consent to and authorize the performance of the following procedures:
Boarding: -----------days From --------------to -------------
Other services / special needs/ special food/ medication(s) adminstration:
1- Note: Vaccinations are essential. In order to protect all animals staying in this facility against contagious diseases, all boarding pets must be up to date in their vaccination within the past 12 months (including Bordetella vaccine for dogs) to avoid the transmission of the Kennel cough disease. Animals that are not fully vaccinated will not be accepted for boarding unless vaccines are updated prior to or upon admission.
2- The owner/agent of the owner, warrant that this (these) animal(s) has been vaccinated against contagious diseases within the past 12 months (proof must be provided) INITIALS ----------
3- The owner/agent of the owner, recognize that the animal’s vaccination status is not up to date and wish to have these vaccines updated today. INITIALS ------------
4- In the event of illness, I the owner/agent of the owner, consent to pay all medical costs incurred in the diagnosis and treatment of the pets condition while under the care of this facility INITIALS-------------
5- Final price may vary from estimates on this sheet. A 50% deposit is required at the time of admission prior to boarding or services being done.
I understand the risks that may be involved. I have had the fees for the above procedures outlined to me and I agree to pay all such fees and charges in full, at the time of the services rendered or discharge of the animal(s) from the hospital. In the event that I am unable to pay all fees in full, the hospital reserves the right to keep the above-mentioned animal(s) hospitalized until such time as all fees are paid.
Date _____________________ Signature of owner/agent ___________________
v Emergency contact person ________________ Phone # ____________________
v Pick ups after closing time will be a charge of $5.00 late fee for every 15 minutes.
INITIAL _______ |
