Please review the following information and fill out the form below when dropping off your pet.Owner's Name* First Last Pet's Name*Drop Off Date* MM slash DD slash YYYY Pick Up Date* MM slash DD slash YYYY Emergency contact name* First Last Emergency contact number*All boarding pets are required to have an exam by MAH within the past year and be current on the following immunizations:Dogs (check all immunizations that are current) Rabies DA2PP Bordetella Cats (check all immunizations that are current) Rabies FVRCP If immunizations were not given by MAH, you must provide written documentation.Please list personal items brought for your pet*Type of food* Wet Dry Feeding Instructions (A.M.)*Feeding Instructions (P.M.)*If you do not provide food (or not enough for the length of stay) we will provide a full container and charge you. Is your pet on medications?* Yes No If yes, what (name and dosage)When was the medication last given?How much was given?I UNDERSTAND IF MEDICAL TREATMENT IS DEEMED NECESSARY FOR MY PET WHILE BEING BOARDED, IT WILL BE PROVIDED. AND THAT I AM RESPONSIBLE FOR THE FEES ASSOCIATED WITH THE TREATMENT WHICH ARE TO BE PAID AT THE TIME OF PICK UP. I ALSO UNDERSTAND THAT I AM BOARDING MY PET AT A HOSPITAL, AND THAT THEY MAY BE EXPOSED TO AIRBORNE DISEASES. MAH WILL NOT BE RESPONSIBLE FOR TREATMENT.Signature*Date* MM slash DD slash YYYY BE AWARE THAT THERE MAY BE TIMES WHEN NO PERSONNEL ARE ON THE PREMISES.NameThis field is for validation purposes and should be left unchanged.
