Boarding Release Form

Date

Client ID#

Name*

Street Address*

Street Address 2

City*

State*

Zip Code*

Phone*

Emergency Contact*

Phone*

Email*

Pet Namel*

Species*

Breed (If Known)

Estimated Age*

Sex*

Color*

Drop off Date*

Drop off Time*

Pick-up Date*

Pick-up Time

Person picking up pet if other than owner

Bath*

Medication*

Scheduled Grooming*

Nail Trim Only*

Personal Items Left (Check all that apply)

Feeding*

Quantity Each Feed*

Preferred Diet*

Extra Play Time ($6.00 each)

Puppy Pops (Frozen Dog Treats)($1.00 each)

Do not administer and medical treatment until specific authorization is given. Please type N/A if this is not your choice.*

We are not liable for any lost items such as toys, bedding, blankets, etc. I have read and understand this agreement. I fully intend to pick up my pet(s) at the above specified date and pay in full at the time. If circumstances change, I will notify Animal Hospital of Whitfield County of a new pick-up date.*

Date*