Boarding Release Form

Client ID:
Client Name:
Address:
City:
State:
Zip:

Species:
Breed:
Sex:
Telephone:
Color:
Markings:

Birth Date:
Arrival date
Departure date and time
Emergency contact number

Are any medicines necessary while boarding? noyes
Give names of any medications and the dosages to be given:

Feeding instructions:

REQUIREMENTS FOR BOARDING

1. ALL ANIMALS MUST BE CURRENT ON ALL VACCINATIONS, INCLUDING DISTEMPER/PARVO, BORDETELLA, CANINE INFLUENZA, & RABIES.
2. ALL PETS MUST HAVE HAD A NEGATIVE INTESTINAL PARASITE (FECAL) TEST WITHIN THE PAST 12 MONTHS. PETS NOT ON A YEAR-ROUND PARASITE PREVENTATIVE MUST HAVE HAD A NEGATIVE FECAL TEST WITHIN THE LAST 6 MONTHS.
3. ALL ANIMALS MUST BE FREE OF EXTERNAL PARASITES (E.G, TICKS, FLEAS, ETC.), OR THEY WILL BE TREATED AT OWNER'S EXPENSE.
4. CHESAPEAKE VETERINARY HOSPITAL HAS MY PERMISSION TO TREAT MY ANIMAL SHOULD THE ATTENDING DOCTOR DEEM TREATMENT NECESSARY FOR THE HEALTH OF THE ANIMAL. I AGREE TO PAY ANY AND ALL FEES ASSOCIATED WITH THE TREATMENT.
5. IF A TRANQUILIZER IS NECESSARY FOR TREATMENT OR HANDLING, CHESAPEAKE VETERINARY HOSPITAL HAS MY PERMISSION TO ADMINISTER SUCH MEDICATION.
6. PETS MAY BE PICKED UP MONDAY- FRIDAY 8:30AM-NOON / 1PM -5:30PM; SATURDAY 8AM - 11AM

(prior arrangements must be made if you would like to pick your pet up at any other time not listed above)

Items brought by owner (medications or food):

We ask that pet owners not leave personal items (e.g., beds, blankets, collars, and leashes) with us, as CHESAPEAKE VETERINARY HOSPITAL IS NOT RESPONSIBLE FOR LOST OR DAMAGED ITEMS.

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

Digital Signature: