Boarding Form - Animal Medical Center of Litchfield

Please make sure to fill out a form for each pet boarding, if forms are not completed prior to boarding we are not able to admit patients for their stay.

Name *

First

Last

Email *

Phone *

Patient Information

Patient Name *

Breed *

Color *

Age *

Check-In Date *

Check-Out Date *

Emergency Contact Information:

First

Last

Emergency Contact Phone

Is your pet on any medications daily? There is an additional fee for our staff to administer medications daily. *

Yes
No

If yes, please list medications:

Does your pet have any allergies? *

Yes
No

If Yes, what is your pet allergic to?

Does your pet need a bath before going home? *

Yes
No

*If Yes, your pet will not be ready for pick up until after 2:00 PM.

Is your pet current on all required vaccines? (Distemper, Rabies and Bordetella)? *

Yes
No

If no, your pet is NOT ELIGIBLE for boarding until these are completed.

Does your pet need to see the doctor for any reason while here at the clinic? *

Yes
No

If yes, please tell us the reason:

If a sedative is necessary for treatment and handling, I give permission for such medications to be administered by our doctor or technician. *

I have read and agree to the above statement.

I authorize Animal Medical Center to do whatever necessary should a medical emergency arise. Payment will be required at the time of Check-Out *

I have read and agree to the above statement.

Your pet must be free of any internal (hookworms,roundworms,whipworms,coccidia and giardia) and external (fleas, ticks, ear mites, etc) parasites or they will be treated at owners expense. *

I have read and agree to the above statement.

Check-In and Check-Out Information

Boarding Check-In and Check-Out will only be during the hours of 8:00 AM - 12:00 PM and from 2:00 PM - 4:00 PM. There will be additional charges for dropping off between the hours of 12:00 PM - 2:00 PM. *

I have read and agree to the above statement.

All boarding pets must be dropped off by 4:00 PM the day of Check-In. This allows our staff to get your pet settled in and situated before the clinic staff leaves for the night. Additional fees will be added for late Check-In *

I have read and agree to the above statement.

You will be charged for the day you drop off regardless of time but will not be charged for the day of Check-Out if you arrive before 3:00 PM. *

I have read and agree to the above statement.

BOARDING ADMIT & DISCLOSURE FORM

Payment of Service. You agree to pay us for the service we will be providing to your pet during their stay with us at the rates set forth at the start of such visit (collectively the “charges”). Prices are subject to change without notice. Charges begin on the day of Check-In. Payment is expected in full on the day of Check-Out.
Reservations/Cancellations. Reservations are required for all boarding pets. If you need to cancel your reservations, please call at least 24 hours prior to your check-in date.
Pet Health and Behavior. We reserve the right to refuse to accept a pet at check-in for any reason, including without limit, if it appears to us that the pet is sick, injured, in pain or that its behavior could jeopardize the health and safety of other pets or our staff.

•If your pet becomes aggressive and not manageable we will reach out to you directly first. If we are not able to reach you, we will call the emergency contact listed to discuss options for your pet.

•You acknowledge that we may contact the appropriate authorities if your pets bites another pet or staff member.

Abandoned Pets. If you do not pick up your pet on the scheduled check-out date, you hereby authorize us to continue to provide the services as set forth in this agreement at your expense. We will attempt to contact you by phone and/or in writing using the information that you have provided, advising you that if your pet is not picked up within 7 business days, your pet will be deemed to be abandoned and that we will deliver the pet to animal control. You understand that you may lose ownership of your pet under these circumstances. You shall remain liable to us for unpaid charges, including without limit the court costs and reasonable attorney fees incurred in the collection of the charges. If you fail to pick up your pet, you release AMC Litchfield from all further liability and responsibility for your pet.

Owner Signature *

Clear Signature

Today's Date *