Canine Boarding Authorization Form Boarding Authorization - Canine Arrival Date * Departure Date * Owner Information Name * Name First First Last Last Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email * Phone * Pet Information Pet's Name * Breed * Sex * MaleFemale Color * Pet Age/DOB * Microchip # Vaccination History NO EXCEPTIONS: We require all dogs have proof of a negative fecal parasite test within 1 month of boarding, as well as current examination, dapp, rabies, and bordetella vaccines. If any of your dogs’ vaccinations or exam are past due, they must be inoculated and examined to board. Negative fecal test results must be obtained prior to board or we will not allow your pet to board. Young dogs that have not yet completed their entire series of vaccinations may not be fully protected therefore owners are required to accept any risks of infection. Please enter the following information: Rabies Vaccine - Given Date * Rabies Vaccine - Due Date * DAPP Vaccine - Given Date * DAPP Vaccine - Due Date * Bordetella Vaccine - GIven Date * Bordetella Vaccine - Due Date * Fecal Parasite Vaccine - Given Date * Fecal Parasite Vaccine - Due Date * Medications, Bathing & Food If your dog will be receiving medication during its stay, the medication must be in the original veterinary-labeled container with instructions for administration. Fees for medications that need to be filled or refilled during the time your dog is boarding will be added to your invoice. Does your dog require medication(s) while boarding? * YesNo Please list the names of those medications, the dosage, and the last time given. * Would you like your dog to receive a bath while boarding? (additional charges will apply) * YesNo Did you bring your own food? * YesNo How often and how much food should your dog be fed? * In Case of Emergency If my dog becomes ill, I request that Coronado Veterinary Hospital provide: * Only life-saving treatment without contacting me or my emergency contact first Medical/surgical treatment it deems necessary Fees should not exceed: Emergency Contact Name * Emergency Contact Name First First Last Last Emergency Contact Phone Number * Requirements Dogs must be picked up between 8am-7pm Monday-Wednesday, 8am-6pm Thursday, 8am-5pm Friday or 8am to 1:30pm Saturday. Discharges after hours are prohibited. The kennel is closed Sundays. Personal items may be left at your own risk. We are not responsible for loss or damage. This facility cannot guarantee the health of any animal, but pledges to provide appropriate care to all boarders. By signing you agree to hold this facility harmless for conditions that often are unavoidable in boarding environments, including, but not limited to, weight loss or gain, rough hair coat, kennel cough, upper respiratory infection, diarrhea, and fleas. All animals must be current on all vaccinations. All animals must be free of external parasites (ex. ticks, fleas, etc.), or they will be treated at owner's expense. I agree to make complete payment to this facility at the time of discharge. I certify that my dog appears to be free of contagious disease and has not bitten anyone within the past ten days. I understand that if I fail to pick up my dog within ten days of notification to the above address, my dog may be considered abandoned and will be handled in accordance with the requirements of state law, and that doing so does not relieve me of my financial obligations to this facility. I acknowledge that in the event of my dog’s illness, the staff at Coronado Veterinary Hospital may not be able to contact me immediately. Nonetheless, they are authorized to initiate appropriate authorized treatment until my agent or I can be reached. I agree to pay all related expenses associated with the treatment of my dog until I am available to discuss further care and related fees with the attending veterinarian. I have read and understand Coronado Veterinary Hospital’s boarding requirements and agree to the hospital's policies. Signature * signature keyboard Clear Date * Captcha Submit If you are human, leave this field blank.
