Alliance Animal - Canine Boarding Form
Pet Owner First and Last Name
Your answer
Pets Name
Your answer
Arrival Date
MM
/
DD
/
YYYY
Departure Date
MM
/
DD
/
YYYY
For the health and safety of all dogs boarding in our facility, we require documentation showing that all pets have current
Rabies, DHP-P and Bordetella vaccinations. In addition, we also require a current Intestinal Parasite Screening test. Should
your pet be due for any of these immunizations and/or an intestinal parasite screen, these services will be provided at the
pet owner's expense. Please note: Pets that are so young that they have not completed their entire series of vaccinations
may not yet be fully protected and, thus, the pet owner understands and accepts any risks of infection.
REQUIRED:
OPTIONAL:
Does your pet have any pre-existing conditions (food allergies, diabetes, kidney failure, etc)?
If so, please provide any special instructions here
Your answer
My pet needs to have an examination by a veterinarian while boarding. Concerns:
If so, how long have symptoms been present?
Your answer
Emergency Contact Information
In case of an emergency, please write down a contact & a phone number.
Your answer
For various reasons like diet change or stress, pets may experience diarrhea and/or vomiting while boarding. In order toensure your pet has the best boarding experience possible and does not become dehydrated or seriously ill, we encouragetreatment of these symptoms. Our recommended medical treatment for pets with diarrhea and/or vomiting while boardingconsists of an examination (at no charge) by a veterinarian, analysis of stool to check for bacteria and/or parasites,antibiotic/anti-diarrheal medication and a special bland diet.
In the event of an urgent medical concern/problem regarding your pet, every attempt will be made to reach you or your emergency contact. However, if you cannot be reached, we need to know how you would like us to proceed.
I give consent for medical care/treatment deemed necessary, even if I am unreachable. Fees are not to exceed the amount I list here.
I do not consent to medical care/treatment without my consent.
Digital Signature
Your answer
I give consent for medical care/treatment deemed necessary, even if I am unreachable. Fees are not to exceed the amount I list here. (Please write in other)
Personal items left with pets must be labeled. Every effort will be made to return item(s) in the same condition as when they were left with us, no guarantee can be made against loss or destruction. Items are left at your own risk.
Digital Signature Required
Your answer
All pets are required to be free of external parasites (fleas and ticks). If external parasites are found, the affected pet(s) willbe treated at the pet owner's expense.
Digital Signature Required
Your answer
Pet owner/agent digital signature
Your answer
Date
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms