Boarding & Daycare Request Form | Companion Animal Hospital

I am requesting Boarding or Daycare

Daycare is available 8 - 6 pm Monday -Friday
Daycare is not available on weekends and holidays.
*

Boarding

Daycare

Requested Check-In Date (after 2:00 PM Monday-Friday, and before noon on Saturday)*

Pick-Up Date*

Boarding pick up times*

I will pick up between 8-11 am

I need a 6:30 pm boarding pick-up

Other

Pet's name*

My Pet is*

Dog

Cat

Rabbit

Other

My dog's weight is:

Large over 50#

Medium 25-50#

Small under 25#

Will your pet require medication?

Medication charge is $7.50 per day (1-3X/day)
*

No

Yes - 1 prescription

Yes - 2 prescriptions

Yes - 3 prescriptions

Will your pet require insulin?

Insulin injections 2 x's per day $7.50 per day.
*

Yes

No

Number of Extra Playtimes

20 minutes of extra play time ($11/day). Morning, noon, and evening outdoor time is included with boarding.
*

Every day

None

Other

Does your pet have allergies?

Food

Medication

Other

Has your pet ever bitten a person?*

Yes

No

If yes, what were the circumstances?

Although Companion Animal Hospital (CAH) exercises precautions to prevent injury or escape of pets, CAH and its staff cannot be held liable for injury, escape, or death of pets kept in its care. I understand that problems may develop and CAH will treat pets as noted below with the owner assuming full responsibility for the treatment expense incurred.

I understand that CAH can not guarantee the health of pets while boarding. I will not hold the hospital or staff responsible for conditions that are unavoidable in boarding kennels, such as but not limited to, weight loss, upper respiratory infections, tracheobronchitis (kennel cough), and diarrhea. I understand all pets admitted to the board must be current on vaccinations and must be free of internal and external parasites or will be treated at the owner’s expense. I understand that in the event of my pet’s illness, the staff will immediately attempt to contact me or my designated contact person to discuss the problem and treatment options. In the event I cannot be reached immediately, I authorize you to initiate appropriate treatment. I agree to pay, in full, all charges for services rendered for my pet.

Should an EMERGENCY arise, I authorize the medical staff to sedate and/or anesthetize my pet and perform emergency procedures as may be necessary (including surgery) for the health of my pet until I can be notified. I agree to pay, in full, all charges for services rendered for my pet.

If I neglect to pick up my pet on the scheduled discharge date and if I receive written notice from you stating that I have to claim my pet(s) and pay the charges incurred during my pet(s) boarding and care, and I failed to claim my pet(s) and pay the charges incurred within 10 days of notice, I understand that the animal(s) shall be considered abandoned by me and I will have no further rights or claim to them. Upon the veterinarian or boarding facility becoming the owner of the animal(s), the veterinarian or boarding facility is relieved of any liability for the animal(s). See Minnesota Statute Section 346.37.

I understand that the CAH is not responsible for loss or damage to personal items left with the pet.

If vaccinations were performed elsewhere, I can provide written documentation of the Rabies vaccination administered by a licensed veterinarian if my pet should bite any person or other pet while at the CAH.

Release*

I have read the above and agree

Boarding or Daycare Request

I am requesting Boarding or Daycare Daycare is available 8 - 6 pm Monday -Friday Daycare is not available on weekends and holidays.*

Requested Check-In Date (after 2:00 PM Monday-Friday, and before noon on Saturday)*

Pick-Up Date*

Boarding pick up times*

Pet's name*

My Pet is*

My dog's weight is:

Will your pet require medication? Medication charge is $7.50 per day (1-3X/day)*

Will your pet require insulin? Insulin injections 2 x's per day $7.50 per day.*

Number of Extra Playtimes 20 minutes of extra play time ($11/day). Morning, noon, and evening outdoor time is included with boarding.*

Does your pet have allergies?

Has your pet ever bitten a person?*

If yes, what were the circumstances?

I am requesting Boarding or Daycare

Daycare is available 8 - 6 pm Monday -Friday
Daycare is not available on weekends and holidays.
*

Will your pet require medication?

Medication charge is $7.50 per day (1-3X/day)
*

Will your pet require insulin?

Insulin injections 2 x's per day $7.50 per day.
*

Number of Extra Playtimes

20 minutes of extra play time ($11/day). Morning, noon, and evening outdoor time is included with boarding.
*