BOARDING/ DROP-OFF CHECK-IN AND RELEASE FORM

PET NAME_______________________________      DATE___________________

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. (Choose One)

                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_____

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

BELONGINGS_____________________________________________________________________________________

______________________________________________________________________________________________- Client Initial_______

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.

I UNDERSTAND THAT LAKESIDE ANIMAL CLINIC IS NOT A 24 HOUR FACILITY.  FOR PETS THAT ARE BOARDED OR HOSPITALIZED, THERE WILL BE TIMES AT NIGHT AND ON WEEKENDS WHEN MY PET WILL BE LEFT UNATTENDED. I UNDERSTAND THAT I HAVE THE OPTION OF TRANSFERRING MY PET TO A 24 HOUR CARE FACILITY OR EMERGENCY CLINIC AT CLOSING TIME. 

 IN THE EVENT OF A FIRE, NATURAL DISASTER OR OTHER EMERGENCY, IT MAY BE IMPOSSIBLE TO GAIN ACCESS TO THE BUILDING.  EVERY EFFORT WILL BE MADE TO KEEP PETS SAFE AND OUT OF DANGER.

Owner Print Name_______________________________________________________

Owner Signature____________________________________________ Date _________________

Daytime/ Emergency Phone_________________________________________________________

STAFF INITIAL__________________