Pets Name *

Owner Name *

First

Last

Phone *

Email *

What is the best way to reach you while you are away?

Phone
Text
Email

Will you be out of the country?

Yes
No

Has your pet urinated / defecated already today? *

Is your dog a fence jumper/climber? *

Yes
No

Hole digger? *

Yes
No

Blanket eater? *

Yes
No

Any known allergies? *

Feeding Instructions: *

My pet requires a special diet which I have provided
Please feed my pet kennel food (Science Diet Sensitive Stomach)

Type of food provided? *

Serving size? *

* In cups

Food schedule *

AM
Noon
PM

Treats/snacks schedule

AM
Noon
PM

Will your pet require medications while boarding? *

Yes
No

Medication Name *

How much/often: *

Would you like to add another medication? *

Yes
No

Medication Name *

How much/often: *

Would you like to add another medication? *

Yes
No

Medication Name *

How much/often: *

Special Instructions for medications: *

(Give with food, pill pockets)

Did you give any medications already today? *

Yes
No

What/when? *

Special instructions: *

(Doesn’t like to be picked up, is blind/deaf)

Pet belongings: *

Exercise Instructions (including contact with other dogs) *

I do not want my dog to be exercised outside the hospital during it’s boarding stay
My dog may be taken outside on a leash only
My dog may be taken outside without a leash; I understand the fence is only 5 ft

My dog is good with other dogs and can have contact with other dogs: *

Yes
No

Sex *

Male
Female

Additional optional boarding services

Extra Walk - $10 each
Pack Yard Time - $10
Solo Yard Time -$15
Senior/puppy relief time (2) - $15

Pets are taken first thing in the morning AM, Noon, and at the end of each day pm. Additional walks or exercise yard time can be purchased. See the form below. Some services will not be performed on Sundays.

Extra walk - how often? *

Daily
Every other day
Midway through stay

Pack yard time - how often? *

Daily
Every other day
Midway through stay

Solo yard time - how often? *

Daily
Every other day
Midway through stay

Senior/puppy relief time (2) - how often? *

Daily
Every other day
Midway through stay

General Boarding Requirements: All pets staying at Alburnett Veterinary Service must have up to date vaccinations, to include Rabies, Da2PP, and Bordetella at least 48 hours in advance. If you received those vaccines elsewhere you must bring proof of vaccines with you. In addition, all pets must be free of fleas and ticks. If fleas or ticks are detected at any time during your pet’s stay with us, they will receive a Frontline treatment at owner’s expense. *

I have read and understand

Medical Policy: If your pet becomes ill while boarding as determined by the trained staff, they will immediately be presented for examination by one of our veterinarians to determine appropriate care deemed necessary. Every effort will be made to contact the owner to inform them of the situation. If your pet requires treatment for their comfort and safety and we are unable to contact you or your emergency contact, treatment will be provided and you will be responsible for the fees incurred. It is explicitly understood that if you (the owner) choose to seek medical care for any condition, or complication of medical care initially received at Alburnett Veterinary Service, you will assume full financial responsibility. *

I have read and understand

Abandoned Pets: Pets which are left 3 days beyond their specified discharge date without notification to Alburnett Veterinary Service shall be considered abandoned and shall become the property of Alburnett Veterinary Service. If we are unable to contact you, Alburnett Veterinary Service will make arrangements for placement or humane care including possible euthanasia if necessary. By initialing you agree to be responsible for all fees incurred including administrative costs, court costs and attorney fees necessary to collect on the account. *

I have read and understand

Contact with other dogs: You agree that your pet is not dog aggressive and can have contact with other dogs during outside exercise time, this will be supervised time in a 5’ fence yard. Fence jumpers are not allowed this option and you understand the possibilities of injury or loss during this activity. If any dog(s) acts out of character or unpredictably and my dog is injured or escapes from the fenced yard, I agree to not hold Alburnett Veterinary Service agents or staff liable in any way for these unforeseen acts. If loss or injury occurs, we will attempt to contact the owner. If we are unable to contact the owner, you authorize medical or surgical treatment if needed to provide for the safety and comfort of your dog and agree to pay for any fees which may result.

I have read and understand

Boarding Consent: I have read and understand the above listed requirements. I acknowledge that Alburnett Veterinary Service Boarding Kennel is not staffed 24 hours a day. I understand that reasonable precautions will be used against injury, escape or death and that Centennial Animal Hospital and its staff will not be held liable provided reasonable care and precautions are followed. I understand that charges will be paid in full at the time of release. Unpaid balances are subject to collection costs including late payment fees, court costs and attorney’s fees. *

I have read and understand

Emergency Contact *

First

Last

Phone *

Owner's Signature *

Date *

Boarding Form

We look forward to seeing you!

Caring for Pets in Alburnett, Iowa.

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