Client Name

First

Last

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone

Arrival Date

Departure Date

Patient Name

Species

Canine

Feline

Breed

Sex

Male

Male Spayed

Female

Female Neutered

Age

Weight

Emergency Contact

Emergency Phone

Would you like your pet BATHED ($35 to $45 +) or a FULL GROOM ($65+) prior to going home?

Yes - Bathed

Yes - Full Groom

Would you like your pet WALKED while boarding? ($17.00/walk)

Yes

How Many Walks?

Would you like your pet to participate in DAYCARE while boarding ($25/half day)?

Yes

Medications Needed?

Yes

List name & dosage for each medication

Please be advised all medications must be in their original vials with legible prescription labels. Medications will not be given if provided in any other form. If medications were prescribed by Thornwood, the prescription will be refilled from stock and charges will apply if not provided in original vials. Medications will be given per label directions.

Current veterinarian if not Thornwood

Requirement For Boarding

I, the undersigned, do hereby give my consent for Thornwood Veterinary Clinic to treat my pet(s) for illness or injury that may occur while boarding. Thornwood Veterinary Clinic will take all reasonable precautions against loss or injury, from escape, disease, theft, fire, death, injury or harm to persons, other pets or property by you, but will not be held responsible for such occurrences. If any pet(s) remains unclaimed after the pre-scheduled departure date, I understand that written notice will be mailed to the address above, and that 7 days after such written notice, pet(s) will be considered abandoned and will become the property of Thornwood Veterinary Clinic. Furthermore, I fully understand that such action does not relieve me from all costs and services incurred at Thornwood Veterinary Clinic.

Today's Date

I have read and agree with the boarding requirements and understand Thornwood Veterinary Clinic's policies.

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Boarding Release Form

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