"*" indicates required fields Animal Care HospitalBoarding Information SheetAre you a new client?* Yes No Client Name* First Last Drop Off Date* MM slash DD slash YYYY Pick Up Date* MM slash DD slash YYYY Cell Phone*Home PhoneCheck-in: any time during office hours. (Proof of current vaccinations must be presented at time of check-in or before.) Pick-up: any time during office hours. (7:30 - 5:00pm MONDAY – FRIDAY) In order for pets to board with ACH, they must be current on the following vaccines and services: Dogs: Bordetella (Kennel Cough), Rabies, and DHLPPC Cats: FVRCP, Rabies, and Felv. All pets will be free of internal or external parasites such as fleas, ticks, and/or intestinal worms as determined by ACH. If the pet is not current on any of these vaccines or services, or ACH cannot verify current vaccinations, ACH will vaccinate the pet at the client’s expense.How may we reach you in case of an emergency during your pet’s stay?*If you will not be available, please leave the name and phone # of someone who will be responsible for making decisions regarding your pet:NameRelationshipEmergency Phone #*Thank you for entrusting us with your pet while you are away. We will do our best to make your pet as comfortable as possible. Please let us know if you have brought any special food, treats, toys, blankets, etc. to use while your pet is staying with us. Please also tell us if your pet needs any medications or particular treatments while boarding.Pet #1 InformationPet's Name*Species* Dog Cat Other Name of Veterinarian where pet was vaccinated (if not here)Phone # of VeterinarianVet services required during stay?* Yes No Services required:* Vaccinations Exam Other Other treatments your pet requires:*Did you bring your own food?* Yes No Food directions:*What toys/supplies did you bring?*Did you bring medication for your animal?* Yes No Medication directions:*What else can we do to make your pet’s stay more comfortable?*Pet #2 InformationPet's NameSpecies Dog Cat Other Name of Veterinarian where pet was vaccinated (if not here)Phone # of VeterinarianVet services required during stay? Yes No Services required:* Vaccinations Exam Other Other treatments your pet requires:*Did you bring your own food? Yes No Food directions:*What toys/supplies did you bring?Did you bring medication for your animal? Yes No Medication directions:*What else can we do to make your pet’s stay more comfortable?I authorize ACH to do whatever they deem necessary for the health and well-being of my pet while they are boarding, ACH including treatment of any internal or external parasites such as fleas, ticks and/or intestinal worms. In the unlikely event of an emergency, ACH will make every effort to reach me or my designated contact. If unable to obtain authorization, ACH has my consent to proceed with treatment. I agree to pay for all expenses relating to such treatment.Signature of Owner or Agent*Date* MM slash DD slash YYYY
