Boarding Form Kildaire

Boarding Contract
Owner Name *

First Name Last Name
Pet Name *
Drop Off/Pick Up Information
Drop Off Date *

Month Day Year
Date
Pick Up Date *

Month Day Year
Date
Pick Up Time *
Primary Contact Name *

First Name Last Name
Primary Contact Phone *
Alternate Contact Name

First Name Last Name
Alternate Contact Phone
Is there someone other than yourself authorized to pick up?

Yes No
If your pet is NOT a patient at Kildaire Animal Medical Center please list your regular veterinarian and contact number.

(In the very rare case of life-threatening illness, we will always stabilize your pet and contact you immediately.)
Hospital Name *
Phone *
For purposes of consent for further treatment beyond stabilization (Please choose all that apply): *

Please call me at my primary contact number to get consent for further treatment If you are unable to reach me, I give permission for my alternate contact to give consent for further treatment
If unable to reach either contact (Please choose ONLY one): *

I give my consent for the Doctor on duty to fully treat my pet I DO NOT give my consent for the Doctor on duty to fully treat my pet
For instances of non-life threatening illness (e.g. diarrhea, ear infection), please indicate your wishes: *

Treat without calling contact(s) Treat and call contact(s) Call before any treatment
Flea Prevention Type Used *
Flea Prevention Date Last Applied/Given *
Feeding Information
Will you bring your own food? *

Yes No
Please list amount to feed in the morning, lunch time, and evening *
Are you bringing treats? *

Yes No
Current Medical Conditions
Does your pet have any current medical condition(s)? *

Yes No
Current medications, dosing, and frequency: ONLY BRING MEDICATION IN ORIGINAL BOTTLES OR PACKAGING
Do you have any other concerns we should be aware of (e.g. anxiety, fear-based aggression, mobility/arthritis issues)? *
PLEASE CHOOSE ANY A LA CARTE SERVICES YOU’D LIKE YOUR PET TO HAVE:
Individual Playtime 15min *

Yes No
If you've selected individual playtime for your pet, how many days would you like your pet to experience it?
Group Daycare w/ Hotel (Behavior evaluation required to participate.) *

Yes No
If you've selected group daycare w/ hotel for your pet, how many days would you like your pet to experience it?
Grooming and Bath ((Exit Bath Doesn’t Include Nail Trim or Ear Cleaning. The prices vary based on size and length of hair coat.))

Deluxe Bath Exit Bath Nail Trim
If you've selected grooming and bath-time options for your pet, how many days would you like your pet to experience it (for each service selected)?
Grooming (by appt. only) Is Your Dog Getting Groomed? *

Yes No
Signature

Clear
Should be Empty:

Boarding Contract

Drop Off/Pick Up Information

Feeding Information

Current Medical Conditions

PLEASE CHOOSE ANY A LA CARTE SERVICES YOU’D LIKE YOUR PET TO HAVE: