Step 1 of 3 33% Boarding Pick-Up and Drop-Off Times Boarding Pick-Up Times Boarding Drop-Off Times Monday-Friday: 8:00 a.m. – 6:00 p.m Monday-Friday: 12 p.m.- 6:00 p.m Saturday: 8:00 a.m. – 4:00 p.m. Saturday: 10:00 a.m. - 4:00 p.m. Sunday: 8:00 a.m. -12:00 p.m. Sunday: 10:00 a.m. – 12:00 p.m. Owner Pet's Name Date of Pick-up MM slash DD slash YYYY Time of Pick-up Hours : Minutes AM PM AM/PM Emergency Contacts (Two people we can contact who WILL NOT be with you while you are away): 1st Contact's Name 2nd Contact's Name 1st Contact's Phone Number2nd Contact's Phone Number1st Contact's Email 2nd Contact's Email *Boarding Rate Are Determined by Animal Species & Weight *These Rates DO NOT include Medical Care or Clean-Ups Needed While Boarding* SPECIAL INSTRUCTIONS Bathing and Clean-Up Charges(Required) I request a bath I decline a bath Date MM slash DD slash YYYY PLEASE READ THE FOLLOWING BEFORE AGREEING: If tranquilization / sedation is necessary for treatment or handling of my pet, I give my permission for Montgomery Animal Hospital to administer such medication(s). I understand that there is a charge for such medications. All dogs or cats entering Montgomery Animal Hospital MUST be up to date on vaccinations and free of external parasites (fleas, ticks, etc.) or they will be treated upon entry at the owner's expense. I authorize Montgomery Animal Hospital to treat my dogs or cat should he or she develop a medical problem while boarding, and I agree to pay for all exams and treatment services rendered. I agree to contact Montgomery Animal Hospital if I am unable to pick up my pet as scheduled. I agree to pay in full for all services rendered by Montgomery Animal Hospital and to pay for those services at the time of discharge. PETS ARE RELEASED ONLY DURING REGULAR HOSPITAL HOURS. If I neglect to pick up my pet within 10 days of the scheduled date, Montgomery Animal Hospital may assume that my pet has been abandoned and may arrange for disposal of my pet in any way deemed necessary. Should I abandon my pet, I understand that I am liable for all charges incurred, that I will be reported to the authorities, and that I may be subject to prosecution. I understand that DISCHARGE TIME IS 9 AM, and that an additional day of boarding may be assessed for all dogs or cats picked up after that time.SignatureDate MM slash DD slash YYYY What number can you be reached at while you are away?MedicationsNameDosageAmount/Frequency Add RemoveBelongingsItemItem Description (color, size) Add Remove Pet's Name First Last Feeding Instructions Our in-house diets are Purina EN prescription dry food and Purina ProPlan canned food. We can feed your pet either of the two or a mixture of dry and canned. Check here if your pet will be fed our in-house diet Check ONE of the following boxes and indicate how much and how frequently you feed. (cups, tablespoons, etc.) Dry Food Only Wet Food Only Both Wet and Dry Cup(s) per mealTimes a dayCan(s) per mealTimes a dayfood provision Check here if you are providing your pet's food during their stay *Note: All food is to be labeled with your pet's First and Last Name with a permanent markerFood Brand How many individual bags of dry food have you brought in?How many cans of wet food have you brought in?AM Feeding# bags of dry# can(s) of wetPlease fill in the blank: Feed __ bags of dry with __ can(s) of wetPM Feeding# bags of dry# can(s) of wetPlease fill in the blank: Feed __ bags of dry with __ can(s) of wetDIETARY RESTRICTIONS (Allergies, Prescription Diet Food, etc.)Have you noticed any of the following over the past month?Vomiting Yes No Diarrhea Yes No Coughing Yes No Sneezing Yes No Limping Yes No Loss of Appetite Yes No Increase of Appetite Yes No Other Yes No Please explain here:
