Boarding Consent Form

Pet Owner Information
Client Name*:

Client Address*:

Client Phone Number*:

Client Email Address*:

Pet Information:
Pet Name*:

Pet Gender*:
—Please choose an option—MaleFemale

Pet Age*:

Pet Breed*:

Additional Pets (if applicable):
Pet Name:

Pet Gender:
—Please choose an option—MaleFemale

Pet Age:

Pet Breed:

How long will your pet(s) be staying with us?*

Drop-Off Date*

Pick-up Date*

Please note: If your pet's stay with us is 10 days or more, we do require a deposit of 75% of the fee at the time of drop-off.

Emergency Contact(s)
Emergency Contact Name*:

Emergency Contact Phone Number*:

2nd Emergency Contact:

2nd Emergency Contact Phone Number:

Food, Belongings, and Medications
I would like my pet(s) fed Aliante's in-house food*:
YesNo

My pet(s) have their own food*:
YesNo

Feeding Instructions-(Must include measurable amounts and frequency of feeding. Example: 1 cup twice daily, morning and night.).

"Normal amount, a few times a day. She normally eats when she's ready."-We do not accept these instructions. Must have measurable amount and accurate frequency. (if needed)*:

Instructions for Treats (if needed):

Does your pet(s) have food allergies?*:

If boarding pets together do they need to be separated during feedings?*:
Not ApplicableYesNo

Does your pet(s) need to be separated from other pets for walks?*:
YesNo

Medications have an additional charge of $3.50/medication per day for administration. All medications must be supplied by owner(s). Please indicate what medication(s) your pet(s) currently take, the amount of medication that's taken, instructions for the medication(s), and the date medication was last given.

All Medications MUST be in original packaging.

Please indicate what medication(s) your pet(s) currently take, the amount of medication that's taken, instructions for the medication(s), and the date medication was last given*:

When was the medicaiton last given? (Date and time):

Please list any behavioral information below, i.e. any aggressive behavior over food/toys, or other animals:

Does your pet(s) have any past injuries, medical problems, or any current conditions?*:
YesNo

Has your pet(s) bitten anyone?*:
YesNo

If yes, what were the circumstances?

Health Requirements

All pets boarding at Aliante Animal Hospital are required to have proof of current vaccinations.

Dogs must be vaccinated for DA2P, Parvo, Annual Bordetella, Influenza, Rabies, and have a current intestinal parasite/fecal test. We do not accept 6-month Bordetella.

Cats must be vaccinated with FVRCP, Rabies, and have a current intestinal parasite/fecal test. We do not require Leukemia.

We only accept vaccines given by a licensed veterinarian, all others will be void. These are minimum vaccination requirements and are necessary for the safety of all animals, and staff, at Aliante Animal Hospital.
You, the owner, must have written proof prior or the same day that all vaccines and fecal are up-to-date.

Agreement:
Aliante Animal Hospital will update vaccines and fecal samples for all boarders at the owner's expense if not up to date. Aliante Animal Hospital will exercise reasonable care of the pet(s) during your pet(s) stay. Although we provide reasonable supervision, pets may escape, injuries occur, and transmittable diseases may happen. In consideration of these services, the owner(s) waives and relinquishes any claims against Aliante Animal Hospital, its officers, owners, employees, and an agent, relating to services provided pursuant to the owner's pet(s), and further agrees to indemnify Aliante Animal Hospital against all such claims.

Please type your name below to indicate you understand the health requirements as stated by Aliante Animal Hospital.*

Please initial the following:
AGGRESSIVE PET BOARDING POLICY: For our purposes, we are defining ‘aggressive’ as any patient that attempts to lunge and/or bite an individual or other animal(s) with the probable intention of doing harm. We would encourage all owners of the aggressive pet(s) to find an alternative to boarding their pet(s) in a boarding facility, such as leaving the pet(s) at home with a caretaker or taking he/she with you during travels. We understand that circumstances do not always allow for these solutions. The nature of such pet(s) will not allow us to extend exercise or grooming procedures to said pet(s), and we will not guarantee the condition of these pet(s) upon the owner’s return.

PICKUP POLICY: If the pet(s) is/are to be picked up by someone other than the owner, arrangements must be made with Aliante Animal Hospital regarding pick up and payments.

If the expected discharge date is changed to a later date, notification and arrangements HAVE to be made. If NO communication is made and the pet(s) is not picked up within the 10 DAYS of expected discharge date, they will be considered abandoned. Aliante Animal Hospital is given the right to handle the pet(s) as deemed best.

By signing below you agree and understand the policies listed in this Boarding Release Form. You also authorize Aliante Animal Hospital to care for your pet during their stay with us and you accept all financial responsibility for any and all charges generated during your pet(s) stay. Thank you for choosing our team to care for your pet(s).:

Treatment the my pet(s) during their stay:

I grant permission for any necessary veterinary emergency treatment and/or care during my pet(s) boarding stay. I realize that I am responsible for the cost and agree with this new policy. Initial Below*:

Aliante Animal Hospital reserves the right to isolate any pet(s) to ensure the safety of all inhabitants including staff, customers, and patients. In addition, there will be no refunds issued to the owner for unforeseen occurrences. Inital Below*:

CPR/Life Threatening Events

By consenting to this service, you are acknowledging that certain fees will apply. If you are not able to be contacted immediately, resuscitation efforts will be continued to be performed at the veterinarian's discretion. If I cannot be reached by phone within 30 minutes of CPR being initiated and my pet is unable to support cardiac or respiratory function on their own, I authorize the doctor on duty to make the decision to discontinue CPR which may result in my pet's death. I grant permission for emergency treatments needed while my pet is boarding.

I agree to heroic measures, including CPR, in case of a life-threatening emergencyI elect a 'Do Not Resuscitate' status in case of a life-threatening emergency

By typing your name below you agree to the terms of our boarding stay and agree to follow them as discussed above.*

Today's Date*