Boarding Intake Form - DOC by iZcr2dLN

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									                                              Boarding Intake Form

Dog’s Name(s):           ____________________________ Breed/description_______________________


Owners name:_____________________________

Phone number where you can be reached in case of emergency                     _________________________


Do you have more than one dog boarding? Yes                 No     If yes, are they sharing a kennel?       Yes      No



FOOD & MEDICATION

When does your dog eat?            AM _____cup(s)                     PM ____cup(s)              Always left out

Is Lucky Pawz providing the food (Diamond Naturals Chicken & Rice Adult)                              YES    NO

Is Lucky Pawz administering medication to your dog?                                                   YES    NO

                            If yes to medication please provide details on back.

Are you leaving a leash?    YES      NO             describe & label _____________________In___Out___

Please list/describe any additional items you are leaving with your dog on the back of this form



Drop off date: _____________________ Pick up date and time: _____________________




                                              TERMS AND CONDITIONS
By signing below I understand that:
1. I have been provided a Lucky Pawz LLC brochure. If not, I will obtain a brochure before signing.

2. I have the right to pick up my dog at any time during regular business hours.

3. I will be charged for all nights that I have reserved for my dog unless 2 days notice is given.

4. Dogs not picked up by 12:30 p.m. Monday- Saturday will be charged for ½ day of daycare.

5. I authorize Lucky Pawz LLC to transport my dog to a licensed veterinarian for medical evaluation and/or treatment should it

be deemed necessary by an owner or employee of Lucky Pawz LLC. I understand that I will be responsible for all charges related

to the medical evaluation and/or treatment.

Signature____________________________                        Date_____________
                                    Please use this space for medication details
    1.   Medication name_________________ dose & schedule___________________________ In___Out___

    2. Medication name_________________ dose & schedule___________________________ In___Out___

    3. Medication name_________________ dose & schedule___________________________ In___Out___

    4. Medication name_________________ dose & schedule___________________________ In___Out___

    5. Medication name_________________ dose & schedule___________________________ In___Out___

    6. Medication name_________________ dose & schedule___________________________ In___Out___

    7. Medication name_________________ dose & schedule___________________________ In___Out___

    8. Medication name_________________ dose & schedule___________________________ In___Out___

*Lucky Pawz LLC is not responsible for items lost, destroyed or damaged. We strongly recommend all items be
clearly labeled. Please ask for a marker if you need to label them.
                     Please use this space to describe all items left at Lucky Pawz.
1._________________________In___Out___                          2.______________________________In___Out___

3._________________________In___Out___                          4.______________________________In___Out___

5._________________________In___Out___                          6.______________________________In___Out___

7._________________________In___Out___                          8.______________________________In___Out___

9._________________________In___Out___                          10._____________________________In___Out___




=========================================================================


Dates and times verified       Y N            All items labeled and listed on sheet correctly   Y N

Prepay (including ½ day if scheduled to be picked up after 12:30pm M-Sat)   Y N   Amount $_______Cash Check CC




IN name__________Date____Time_____OUT name__________Date______Time______

								
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