2018 Low Income Boarding Request
Please Note:
1.) Low Income Boarding is for short term boarding (30 days or less) ONLY
2.) Pets must meet the medical requirements listed on the Low Income Boarding information page
3.) Definite check-in and check-out dates are required
4.) All fees are due at the time of check-in (no exceptions)
5.) Complete one request form for each pet that requires boarding

If you are unable to fulfill the requirements for Low Income Boarding, you may be eligible for our Temporary Care Program.

Please answer all questions as accurately and thoroughly as possible.

Your First and Last Name *
Your answer
Address (Street, City, State and Zip Code) *
Your answer
Email Address *
Your answer
Phone Number: *
Your answer
Emergency Contact Name: *
Your answer
Emergency Contact Phone: *
Your answer
Emergency Contact Email" *
Your answer
Reason for Boarding: *
Your answer
Check in Date: *
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DD
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YYYY
Check Out Date: *
MM
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DD
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YYYY
Pet Species *
Requested Kennel Size: *
Select the applicable option: *
Required
Pet's Name: *
Your answer
Pet's Age: *
Your answer
Pet Breed: *
Your answer
Has your pet ever exhibited aggressive behavior towards people or other animals? *
Your answer
Does your pet display any destructive behavior (e.g., chewing, biting, scratching, etc.)? *
Your answer
DOGS ONLY - Vaccinations: You MUST provide the following vaccination records prior to check-in:
CATS ONLY - Vaccinations: You MUST provide the following vaccination records prior to check-in:
Does your pet require any medical care while staying at Lost Our Home (e.g., insulin, medication, etc.)? NOTE: There is no additional fee for animals requiring medical care. *
Your answer
Are you a Military Veteran? *
Does your annual income fall under the Annual Income Poverty Guideline? NOTE: This information is for internal use only and will not be used to determine the intake of your animal(s). *
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How many people reside in your home? *
Your answer
How many people in your household are age 17 or younger? *
Your answer
I certify that I am unable afford traditional boarding services at this time. *
Required
I understand that in the unlikely event that my animal becomes ill or injured, or if my animal has a pre-existing condition which is aggravated by its stay and requires medical attention, Lost Our Home (LOH) will attempt to notify me or my Emergency Contact. If LOH is unable to make contact, LOH, at its sole discretion, may engage the services of a 24-hour emergency veterinarian clinic of our choice and/or administer medicine or give other necessary attention to my pet, and I authorize LOH to provide any such service at my additional expense. In case LOH believes the issue to be critical, I understand that LOH may take my pet to the veterinarian first before trying to contact me. I understand that if I refuse medical treatment for my animal, LOH, at its sole discretion, may engage the services of a veterinarian and/or administer medicine to ensure your pet is as comfortable as possible until picked up by me or my Emergency Contact, and I authorize to provide any such service at my additional expense. If I cannot cannot be reached, LOH will make healthcare decisions for my pet based on the recommendations of available professionals. *
Required
I understand that I must pay for all services at time of drop-off of my pet(s) *
Required
I understand that Lost Our Home and our representatives and employees will not be liable or responsible for any lost, stolen, or damaged personal property belonging either to the pet parent or the animal. *
Required
I understand and agree to assume all risks involved on behalf of or in connection with Lost Our Home Pet Foundation Inc. I agree to hold Lost Our Home Pet Foundation Inc., it’s successor organizations, any representatives thereof or any third parties harmless for any injury(s), loss or damages which I might sustain during my time at the shelter. This waiver includes myself, all of my family members and descendants forever from seeking any legal action whatsoever against Lost Our Home Pet Foundation Inc. its successor organizations, any representatives thereof or any third parties.
I understand that if my dog is not picked up within six (6) calendar days after the scheduled pick-up date, or the pet parent refuses to pay the agreed upon charges, the animal shall be deemed abandoned and become the property of Lost Our Home. *
Required
I agree that I have read this entire Agreement/Contract and agree to its terms. *
Required
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