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 (at an additional cost) *

Yes
No

Give names of any medications and the dosages to be given (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 *

Owner to list and label ALL personal belongings: *

Vaccination Policy

To prevent the spread of disease while your pet is in our care, dogs must be current on rabies, bordetella (within the last 6 months), influenza and distemper 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 prior to 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 dog can still contract Kennel Cough or another illness during their stay at VVC (Village Veterinary Clinic). Owner specifically agrees that VVC shall in no way be responsible should owner's dog contract Kennel Cough or another illness while in the care of VVC. *

I have read and understand

To help us take the best care of your dog, please indicate the appropriate answers:

Has your dog ever had a seizure? *

Yes
No

Last seizure date *

Treatment *

Does your dog have hip dysplasia? *

Yes
No

Does your dog have allergies? *

Yes
No

Please list allergies *

Has your dog been ill or in the care of another veterinarian in the last 30 days? *

Yes
No

Please explain *

Any Medical / Health Concerns *

We want to know your dog as well as we can. The information below will help us take the best care of your dog while boarding.

Chews Furniture, bedding, towels, etc? *

Yes
No

O.K. to leave bedding/towels in kennel? *

Yes
No

Housebroken? *

Yes
No

Walks well on leash? *

Yes
No

Has your dog ever bitten another dog or person? *

Yes
No

Please explain *

Behavioral issues or destructive habits when left alone? *

Yes
No

Please explain *

Has your dog ever jumped or climbed over a fence? *

Yes
No

How high? *

Is there any type of person (men, women, children) your dog routinely dislikes or fears? *

Yes
No

Describe *

Are there any other areas on your dog's body that does not like to be touched (ears, paws, etc.)? *

REQUIREMENTS FOR BOARDING

All animals must have proof of and be current on annual exams and all vaccinations: Rabies, DAP, Bordetella & Influenza.
All animals must be free of external parasites (ex. ticks, fleas, etc.), or they will be treated at owner's expense.
Non-spayed females who are in heat during their stay require extra care: an additional fee will be charged.
All pets are boarded or otherwise handled or cared for by the Kennel without liability on Kennel's part for loss or damage by disease, theft, fire, death, running away, injury, or harm to persons, other animals, or property by said pet, or other unavoidable causes, due to diligence and care having been exercised.
Village Veterinary Clinic has my permission to do whatever is necessary should an emergency arise.
If a tranquilizer is necessary for treatment or handling, Village Veterinary Clinic has my permission to administer such medication.
Hospital diet is Iams Intestinal Low Residue dry or we will be happy to feed the pet food you provide in a labeled, sealed, varmint proof container.
***Pets may be picked up or dropped off between 8:00am-5:30pm Monday through Friday. Saturdays and Sundays at 8:30am or 3:30pm by appointment. Holiday pick up/drop off times are by appointment only at 8:30am or 3:30pm for an additional charge.
If pet is to be picked up by an individual other than the owner, the owner must provide written authorization for release of pet in advance and prepay fees or have individual bring payment at time of pickup.
If the doctor feels it is in the best interest of your pet for boarding staff to perform additional tender loving care, there will be an additional charge.
It is understood by Kennel and Owner that all provisions of this Contract shall be binding upon both parties for this visit and all subsequent visits. This Contract contains the entire agreement between the parties.
If boarded animals are unable to eat together at meal time, they will require separate kennels for the length of their stay.
***Owner is responsible for Listing & Labeling ALL PERSONAL BELONGINGS prior to dropping off. Village Veterinary Clinic is not responsible if personal belongings are lost, stolen, or damaged***

I have read the above requirements *

I have read and understand

Emergency Contact Person/Authorized Individual *

First

Last

Emergency Contact Phone *

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

I have read and understand

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

I have read and understand

We Do Not Monitor Animals After Hours

Cage Type

Nightly Rate

Online Forms

Canine Boarding Release Form