Owner’s Name *

First

Last

Pet's Name *

Email *

(Primary) Phone *

(Secondary) Phone

Drop-Off Date *

Pick-Up Date *

Requirements for Boarding

▪ All animals must be current on ALL vaccinations (Proof Required)
▪ All animals must be free of external parasites (fleas, ticks, etc), or they will be treated at the owner’s expense.

Feeding Instructions: (Please check one/all that apply) *

Feed regular hospital maintenance diet.
Feed special diet, as follows:

Food Type *

Dry
Wet
Both

Feeding Times *

AM
PM
Both

Feeding Instructions

Please list any belongings that are left with your pet:

Medications:

Administer medication(s) as follows:

Has your pet had any recent surgeries/medical conditions that would require extra attention? *

Yes
No

Please explain: *

Additional Services:

Checkboxes

I, the undersigned owner or authorized agent, hereby authorize Parkside Animal Hospital (hereinafter “Hospital”) to board my pet. The Hospital will attempt to notify me if my pet becomes ill while boarding. If the owner or authorized agent cannot be reached, the Hospital is granted consent to administer any medical or surgical treatment deemed necessary for my pet by a veterinarian.

I authorize any treatment to be administered as indicated above (hereinafter “additional services”) while boarding. The Hospital will use all reasonable precautions against injury, escape, or death of my pet, but will NOT be held liable or responsible in any manner, as I thoroughly understand and assume all risks. As the owner or authorized agent of the above-named animal, I acknowledge that I am responsible for all boarding fees, any associated costs, and payment IN FULL for the services listed above at the time my pet is discharged.

I also understand that leaving personal belongings (blankets, toys, leashes, collars, carriers, etc.) with my pet while boarding is discouraged. Should I choose to do so, I agree that Parkside Animal Hospital is not responsible for lost or damaged items.

Your signature below indicates that you have read and understand the above information and that you release Parkside Animal Hospital and its staff from any liability in the event of complications. *

I have read and agree to the terms of Parkside Animal Hospital’s Boarding Policy

Signature *

Clear Signature

Today's Date *

I Consent for the Following Person(s) to Pick Up My Pet(s) on My Behalf:

Name 1

Name 2

Name 3

Name 4

Boarding Intake Form