Name: East Padden Animal Hospital
Address: 15721 NE Fourth Plain Blvd., Vancouver, WA, 98682, USA

Date*
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Client ID#
Admitting Staff Member*
Check-in Date*
MM slash DD slash YYYY
Time*
- AM
- PM
Pick-up Date*
MM slash DD slash YYYY
Time*
- AM
- PM
Owner's Name*
First Last
Phone Number*
Emergency Contact*
First Last
Emergency Contact Phone*
Pet Information
Pet Name*
Breed*
Sex*
Age*
Color*
Are vaccinations current?*
- Yes
- No
Current Vaccinations are Required.
Dogs: Rabies, DAP, Bordetella, Cats: Rabies, HCP
Special Diet?*
- Yes
- No
(If you did not bring your own food, we will feed Purina EN diet for dogs and OM diet for cats).
Feeding Schedule (How much, How often):*
Food preference:*
- Canned
- Dry
- Both
Time your pet last ate:*
Any food sensitivity:*
Toys, blankets, etc., brought with pet:*
How frequent would you like to be updated?
List any procedures, vaccines, etc. your pet requires:*
Medications: (name of medication, last given, dosage, how often)*
(There is an additional charge of $6.00 per day to medicate boarding pets with oral medications. There are additional costs for injections while boarding.)
Add another pet?*
- Yes
- No
Pet Name*
Breed*
Sex*
Age*
Color*
Are vaccinations current?*
- Yes
- No
Current Vaccinations are Required.
Dogs: Rabies, DAP, Bordetella, Cats: Rabies, HCP
Special Diet?*
- Yes
- No
(If you did not bring your own food, we will feed Purina EN diet for dogs and OM diet for cats).
Feeding Schedule (How much, How often):*
Food preference:*
- Canned
- Dry
- Both
Time your pet last ate:*
Any food sensitivity:*
Toys, blankets, etc., brought with pet:*
How frequent would you like to be updated?
List any procedures, vaccines, etc. your pet requires:*
Medications: (name of medication, last given, dosage, how often)*
(There is an additional charge of $6.00 per day to medicate boarding pets with oral medications. There are additional costs for injections while boarding.)
If you are boarding multiple pets and wish them to stay together, please read and initial the following:
- I have requested that my pets be boarded together in the same kennel, and I understand that even pets who get along at home may act differently when in an unfamiliar environment. I agree to release East Padden Animal Hospital and its employees from all claims should my pets harm each other while being boarded at this facility.
Please read and accept the following:
Authorization for boarding:*
- I am the owner or guardian of the above described animal(s) and have the authority to execute this consent for boarding. I hereby consent and authorize East Padden Animal Hospital to board the above stated pet(s) and to medicate if needed per the instructions on the reverse of this form. If this animal is found to have fleas at the check-in exam, he/she will be treated with Capstar at a cost of ($6.50).
*
- I understand that boarding charges run from 12pm noon to 12pm noon. That time period is broken up into half days, with a check-out deadline at noon. If i pick up my pet after that time, I will be charged for another days boarding.
*
- Provided that reasonable care and precautions are followed, I release East Padden Animal Hospital and its employees, staff and representatives from any claim should my pet be injured or property damaged (including injury to other pets) through the pet’s actions while boarding, e.g., broken teeth from chewing on kennel bars, abrasions from rubbing on kennel doors, damage to toys, harnesses, bedding, or other personal items as well as injuries sustained from climbing out of kennel runs.
*
- My pet has not had any signs of respiratory illness (such as coughing, sneezing, nasal discharge, eye discharge, etc.) or been exposed to another pet with respiratory illness in the past 2 weeks.
*
- I authorize East Padden Animal Hospital to provide appropriate medical care in the event of significant illness or injury that is life threatening or causing significant discomfort/distress to my pet. If medical care is declined by me, I understand that I will be expected to arrange pick up of my pet from boarding immediately.
- I authorize East Padden Animal Hospital to administer prescription calming/sedation medication in the event of significant anxiety or aggression while boarding. If my pet’s aggression causes bodily harm to East Padden staff, I understand I may no longer be able to board my pet at East Padden.
*
- I understand that sending personal items to “camp” is a risk. These items may become lost or damaged. Should I chose to leave personal items behind, I will not hold East Padden responsible for any loss or damage. East Padden is happy to provide beds, toys, bowls, etc. Our policy is to wash and change these items daily.
Signature*
Date*
MM slash DD slash YYYY
CAPTCHA

Pet Information

Please read and accept the following: