Owner Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Pet's Name *

Breed *

Color *

Mark *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Weight *

Rabies *

Arrival Date *

Drop Off *

Discharge Date *

Pick Up *

Owner authorizes the following Services/Vaccinations DURING STAY: *

Bath (Dogs only) at an additional cost *

Yes
No

Medications/dosages necessary while boarding (at an additional cost) *

Heartworm Preventative *

Yes
No

Brand *

Last date applied/given *

Flea control *

Yes
No

Brand *

Last date applied *

Veterinarian

Veterinarian Phone

Food Choice *

Own food
VVC food

Feeding Instructions *

Does your pet chew on furniture, bedding, towels, etc? *

Yes
No

Is it OK to leave bedding/towels in your pet's kennel? *

Yes
No

Owner to list and label ALL personal belongings: *

Vaccination Policy

To prevent the spread of disease while your pet is in our care, your pet must be current on rabies, distemper, bordetella (dogs only, within the last 6 months), and influenza vaccinations. It is the responsibility of the owner to provide proof of vaccination history from a veterinarian for each animal boarding. To insure the protection of all the pets under our care, the vaccinations listed above must be current prior to boarding. Animals whose vaccinations are not current will be examined and vaccinated by Village Veterinary Clinic (VVC) before admittance at the owner's expense or they will not be allowed to board.

Owner understands that even if owner’s dog(s) is vaccinated against Kennel Cough (Bordetella), there is a chance that the owner’s dog can still contract Kennel Cough during their stay. Owner specifically agrees that VVC shall in no way be responsible should owner's pet contract any illness while in the care of VVC. *

I have read and understand

***Pets may be picked up or dropped off between 8:30am-5:00pm Monday through Friday. Saturdays and Sundays 8:30am or 3:30pm by appointment. Holiday pick up/drop off times are by appointment only at 8:30 A.M. or 3:30pm for an additional charge.*** *

I have read and understand

***Village Veterinary Clinic is not responsible if personal belongings are lost, stolen, or damaged.*** *

I have read and understand

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

I have read and understand

**If you are picking up after hours pre payment or credit card number on file is required. *

I have read and understand

Emergency Contact Person/Authorized Individual *

First

Last

Emergency Contact Phone *

We Do Not Monitor Animals After Hours

Cage Type

Nightly Rate

Online Forms

Boarding Re-Release Form