Name *

First

Last

Pet's Name *

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Drop Off Date *

Pick Up Date / Time *

Date

Time

Boarding Policies:

All pets must be up to date on vaccinations. Any due or overdue services will be performed on the first day of boarding at owner's expense.

All animals must be free of internal and external parasites or they will be treated at owner's expense.

Heritage Animal Hospital has my permission to do whatever is necessary should medical care be necessary.

If the DVM deems it necessary for the health of a pet, anti-anxiety medication will be used for treatment or handling.

Daily Rates:

The following are standard boarding rates per night of your pet’s stay. There may be additional charges for animals requiring additional nursing care.

Canine Boarding Rate: $46.00

Feline Boarding Rate: $35.00

Allergies or Health Concerns: Please list any new allergies or health concerns your pet has.

Food: All pets boarding at Heritage Animal Hospital will be fed high quality gastroenteric food unless an alternative food is provided by their owner. Please note your pet’s normal amount and feeding schedule below.

Medications: Please list all medications your pet is taking and indicate when they are given. Please also note which medications have been given today.

Personal Belongings: Please list any other personal belongings that will be staying with your pet.

Other Services: Please list any other services you would like to have performed while your pet is staying with us.

Comments: Please list anything else we should know to make your pet’s stay as comfortable as possible.

The undersigned hereby warrants that he or she is the owner or authorized agent for the owner of the above animal and does hereby request, consent, and authorize Heritage Animal Hospital, its owners, veterinarians, personnel and agents to groom, care for, and treat said animal. The undersigned acknowledges this facility is not equipped with an on-site fire suppression sprinkler system. I further understand this facility is not staffed 24 hours a day and my pet(s) will be unattended after closing hours until opening hours. The undersigned acknowledges that no guarantees have been made except the reasonable precautions against injury, escape, or illness with the understanding that the undersigned will remain fully responsible for the cost of all services provided by Heritage Animal Hospital and its authorized agents and professionals. This agreement releases Heritage Animal Hospital, its owners, employees and agents from any and all liabilities, claims or expenses arising from my pet's boarding stay, including but not limited to injuries, illness or death. *

Owner's Signature

Date *

Boarding Registration Form

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