Decatur Boarding Release Form

Boarding Information

Client Name

Patient Name

How would you prefer to be contacted while your pet is boarding - call, text or email? Write "CALL" and provide phone number(s) or write "TEXT" and provide the cell number or write "EMAIL" and provide the email address.

Primary Emergency Telephone Number:

Secondary Emergency Telephone Number:

Have you already made the boarding reservation? Yes No

Is this pet currently a patient of The Village Vets? Yes No

If not, please provide the name and phone number of the vet clinic that has your pet's current vaccine history.

Boarding Entry Date (Dropping Off)

Boarding Exit Date (Picking Up)

Special Instructions/ Diet/ Medications to be given while boarding:

Medical Services/ Treatments to be provided while boarding:

Boarding Agreement

In case of illness or injury, I, the undersigned, do hereby give my authorization and consent for the doctors of the hospital to treat any illness and/or injury of my pet(s) while they are being boarded at The Village Vets. I also understand that these services performed on my pet(s) during The Village Vets of Decatur’s afterhours will be charged the same fees as Emergency After-Hours.

The Village Vets are to use all responsible precautions against illness, injury, or escape of my pet(s), while boarding at this facility, but they will not be held liable or responsible in any manner whatsoever, under any circumstances, on account of the care, treatment, or safe keeping of my pet(s), as it is thoroughly understood that I assume all risks.

Should the circumstances arise that my pet(s) remain unclaimed after the date which I have stated as the pick-up date, I understand that written notice will be mailed to my current address. Seven days after such written notice the pet(s) will be considered abandoned and may be disposed of, or destroyed, as the hospital deems best. It is further understood that such action will not relieve me from paying all costs of the services, including the cost of the boarding service.

The Village Vets promotes a flea and tick free environment. Therefore, if fleas and/or ticks are noted on your pet(s) upon their arrival or while here, an appropriate preventative will be administered. You will be charged accordingly and such charges will be applied to your bill.

My pet has been fully vaccinated within the past 12 months. If I cannot show proof of such vaccinations, then I give permission for the hospital to administer vaccinations and perform a doctor exam as required for the boarding of my pet(s). For cat boarding, a FeLV/FIV test must have been performed within a year for cats that go outdoors and within three years for indoor only cats.

The Village Vets is not responsible for clients/pets personal items such as , leashes/collars/toys/bedding, that are left at The Village Vets during their pet’s visit.

I have read and understand the authorization and consent.

Signature

NEW CLIENTS ARE REQUIRED TO PAY FOR BOARDING, AND ANY SERVICES TO BE PERFORMED WHILE BOARDING, AT THE TIME OF DROP OFF.

Vaccinations Required

Canine:

DHPP
Rabies
Bordetella

Feline:

FVRCP
Proof of Feline Leukemia/FIV Test
Rabies

Signature of Owner

Date

Security

Decatur Boarding Release Form

*Vaccinations Required*

Vaccinations Required