BOARDING/ DROP-OFF CHECK-IN AND CONSENT FORM

PET NAME_______________________________      DATE____________________

BOARDING

My pet will be boarding until____________.         
 Will pick up             BEFORE NOON      AFTER  NOON

Boarding beyond one month requires payment in full after 30 days and every 30 days thereafter. 

If client fails to make payment or pick up pet after 30 days, then the pet will be considered abandoned

and become LAC’s property.                                                                                                                CLIENT INITIALS____­­­­­­­­­_

All pets with fleas will be administered a Capstar for $7.00.  Long-term flea control should be purchased at checkout.

If medical problems develop while boarding, there will be additional charges for the treatments performed.

            You have my permission to proceed with any treatments without contact……………………….._______

Call first and if unable to contact, proceed with treatment ………………………………………._______

DO NOT perform any treatments, including emergencies, without contacting me first…………._______

DROP-OFFS/ BATHS     (For examinations, the doctor will call after examining your pet)

CHOOSE ONE

Please call me when my pet is ready to go home………………………………………………………………………._______

I will come in to pick up my pet at ____________am pm…………………………………………………………….._______

VACCINATIONS

                As a way of protecting all of our boarders, we require all of the following vaccinations:

                DOGS – RABIES, DISTEMPER, PARVO, BORDETELLA

                CATS – RABIES AND DISTEMPER

My pet has been vaccinated for all of the above diseases as recommended   ______________

My pet is not current on all vaccinations.  Please vaccinate as needed          ______________

DENTAL/ MICROCHIP

Please insert an ID microchip in my pet while under anesthesia.  I understand there is an additional charge.                          YES____NO____

Please perform a dental cleaning on my pet while anesthetized.  I understand there is an additional charge.                            YES____NO_____

OVERALL CONSENT

I certify that I am the owner of the above pet, and do hereby give my consent and authorize Lakeside Animal Clinic and its staff to perform any
procedure or treatments that the doctor deems necessary for the health and safety of my pet while under their care and supervision.  I do hereby release
Lakeside Animal Clinic and its staff from any and all liability for performing the above-mentioned procedures.  I realize that I am responsible for payment
in full for all treatments at the time that my pet is discharged.  If I neglect to pick up my pet within 11 days of written notice that he/she is ready for
release and mailed to the given address, you are then authorized to dispose of my pet as you see fit.  Abandonment does not release me from my
obligations to pay the bill.

Owner Print Name_______________________________________________________

Owner Signature____________________________________________ Date _________________

Daytime/ Emergency Phone_________________________________________________________

Patient has been checked for fleas      Staff Initial ______  FLEAS:   YES   NO  ____CAPSTAR GIVEN