Online Pet Boarding Release Form - Chester Valley Veterinary Hospital

Client Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Patient Name *

Species *

Breed

Sex

Male
Female

Color *

Markings

Birth Date

Designate an Agent - At Chester Valley Veterinary Hospital (CVVH) our goal is to give your pet the best loving care while you are away. In order to do so, you must provide an alternate contact person to act as your Agent if we are unable to contact you. This person must bu over the age of 18 and should NOT be traveling with you if you are going out of town. You give this Agent full authority to make any and all decisions related to the health and care of your pet. *

I have read and understand

If Your Pet Gets Sick - All pets boarding with us are required to be vaccinated and have a current fecal exam. We also recommend that they be on a preventative medication for parasites such as fleas and lice. However, it is still possible for pets to become ill. Should your pet require medications or medical treatment of any kind, CVVH will attempt to contact you or your Agent using the numbers you provide. If you and your Agent are unreachable the Doctors at CVVH will provide your pet with the needed treatment prior to your authorization. You understand that CVVH will use all reasonable precautions against illness, loss, or injury of your pet. However, you will not hold CVVH liable or responsible under any circumstances on the care, treatment, or safe keeping of your pet and you assume all risks and financial responsibility. *

I have read and understand

Boarding Fees - At the time your pet is scheduled for boarding, CVVH requires a deposit of your pet's estimated boarding charges. This deposit is refundable if you cancel the reservation more than 7 days prior to drop off date, however if you cancel within 7 days or less of drop off date then your deposit is no longer refundable. Nor is it available for future reservation use. You agree to pay CVVH all fees for additional boarding or other services provided in full at time of check out. Charges begin on the day you leave your pet. Check out time is at 1 :00pm. If your pet is picked up after 1:00pm on the day of check out, you will be charged for an additional day of boarding. • Clinic Emergency *

I have read and understand

Clinic Emergency - In the event of an emergency or natural disaster. CVVH will attempt to contact you or your Agent to retrieve your pet. You agree to authorize CVVH to transport and/or make temporary arrangements for the care of your pet until you or your Agent is able to retrieve your pet. You understand that all efforts will be made to safely evacuate your pet, but that may not always be possible. *

I have read and understand

Personal Belongings - CVVH wants your pet to be as happy and comfortable as possible. You are welcome to leave personal items from home (blankets, beds, toys, ect.) for your pet. Please do not leave items that are valuable or irreplaceable. CVVH is not responsible for the damage or loss of any items left with your pet. *

I have read and understand

Abandonment - CVVH understands that unexpected events arise and you many not be able to pick up your pet on your scheduled date. Please remember that changes will continue to accrue if your pet boards longer than expected. You or your Agent must contact CVVH as soon as possible if plans change and your pet will not be picked up as scheduled, If no contact has been made by yourself or your Agent within 24 hours after your scheduled pick up date, CWH will attempt to contact you and your Agent a total of three separate times (twice by phone, and finally, by certified mail), If CVVH receives no communication within 10 days of the certified letter being mailed your pet will be considered abandoned and will be deemed CVVH's property. You will still be held accountable for all charges. *

I have read and understand

I have read the boarding requirements and understand the hospital's policies *

Digital Signature

Contact Number *

Agent Name *

Agent's Phone Number *

Expected Date of Pick Up *

Did you bring your own food? *

Yes
No

If not, we feed Science Diet Sensitive Stomach and Skin kibble. *Additional charges will be added for prescriptions diets.*

Feeding Instructions - Amount and How Often? *

Does your pet have any food allergies or other special feeding instructions?

Are any medicines necessary while boarding? *

Yes
No

Give names of any medications and the dosages to be given: *

Please list all things you brought with your pet for boarding (beds, blankets, toys.. etc.):

Please let us know if there"any extra procedures or services you would like while your pet is boarding here. Specific playtime activities:free Boarding at Chester Valley includes 15 minutes per day (except Sunday) of 1-on-1 time with our staff. We try to find activities that each pet enjoys (fetch, snuggling, extra time outdoors) Does your pet have any particular preference?

Please let us know if there"any extra procedures or services you would like while your pet is boarding here. Specific playtime activities: free — Boarding at Chester Valley includes 15 minutes per day (except Sunday) of 1-on-1 time with our staff. We try to find activities that each pet enjoys (fetch, snuggling, extra time outdoors). Does your pet have any particular preference?

*All services and extras will be added to boarding fees*

Wet food or Special Diet - Price varies
Dental estimate - free
Yearly blood work - Price varies, please discuss with our staff
Spa day (includes nail trim, ear cleaning, bath & brush. Anal glands also included for small pets) $42-82
Nail trim - $20
Bath - $22 - $42
Grooming - Prices varies
Other

Please specify type of food- *

Please specify what you would like done during grooming- *

Other - Please specify- *

If your pet is staying for longer than one week, would you like Healthy Pet updates during their stay? - Free *

Yes
No

Do you prefer updates by: *

Phone
Text
Email

Phone Number *

Email *