Client Information

First Name

Last Name

Email

Patient Information

Pet's Name

Boarding Information

Today's Date

Pick-up Date

Pick-up Time

List any additional services needed while here:

(bathing, vaccinations, etc)

Playtime (per day)

Your pet can have up to two playtimes daily on Monday-Friday. (up to 10 per week). Each playtime lasts for 15 minutes and is an additional charge.

None

One

Two

Medications

(List each medication, dosage, and when due.)
All prescription medications must be provided in original container with clearly labeled instructions.
There is an additional charge for each administration of meds.

Special Diet

There is an additional $2 charge for each feeding unless you bring your own food. Our kennel food is Purina Sensitive Stomach, which will be given otherwise.

Feeding Instructions

How much and how often:

Items left

Please limit to 2. (We are not responsible for any items left)

Local Emergency Contact

Name

Number

Boarding Requirements:

- All pets must be current on required vaccinations before being admitted to the kennel. If vaccinations cannot be verified, your pet will be vaccinated upon admission.
- Any pets with fleas and/or ticks at the time of admission will be treated at the owner’s expense.

I have read and understand the above. If my pet becomes sick while boarding I give Southwind Animal Hospital permission to administer necessary treatment at my expense.

Signature

Date

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Boarding Consent Form