Bed & Breakfast
                                                                                    Check-In Sheet

Owner: ___________________________                          Pet(s): ___________________________

Drop-off Date: ______________               Pick-up Date: _______________ Pick up/Drop off
Drop-off Time: ______________               Pick-up Time: _______________       Hours:
                                                                            Mon-Sat 9 am – 5 pm
                                                                           Sun. 6-7pm
Feeding Instructions:
Brand of food: (Dry) _________________________________________________________
               (Canned/Raw) _________________________________________________

Feeding Instructions: Please Identify Amounts

AM          Cups PM           Cups When did your pet last eat?_____________
Additional feeding instructions: ______________________________________________
                                        (example: Mix wet food with a 1/4 cup dry in PM)

Any known allergies or sensitivities? Yes □ No □
If yes, please describe: _______________________________________________________

Is your pet on any medications or supplements?
Yes □ (Fill out Med/supplement form) No □

Any specific instructions related to handling your pet?
(i.e. food or toy possessive, fear of men/women, potty or feeding habits, anything else we should know, etc.)

Please list all articles you brought for your pet (toys, towels, collar, leash, etc.):

                                                                                        Employee: __________
                                     Pet Care Rates & Discounted Packages

                                                       Small                Med                      Lg                  X-Lg
                                                      ≤ 20 lbs            21-40 lbs               41-80 lbs             81+ lbs

 □ A - Social dog 10% off nightly rate               $18/night           $19.80/night        $21.60/night           $23.40/night
  Basic, PLUS:
  4 hrs daily in Dog Daycare (M-S)                                                   $16/day*
   1 extra 15 daily**                                                                  $10 ea

 □ B - Active dog 25% off nightly rate               $15/night           $16.50/night          $18/night            $19.50/night
  Basic, PLUS:
  8 hrs daily in Dog Daycare (M-S)                                                   $32/day*
   2 extra 15 daily**                                                                 2 for $20

 □ C - Pampered Pouch 25% off nightly rate           $15/night           $16.50/night          $18/night            $19.50/night
  Basic, PLUS
  8 hrs daily in Dog Daycare (M-S)                                                   $32/day*

  2 extra 15’s** 10% off                                                             2 for $18
  Spa Package: Bath, blow dry, pedicure,             $22.50               $31.50                  $40.50               $49.50
   cologne – 10% off

                                                       Small                Med                      Lg                  X-Lg
                 Boarding Only                        ≤ 20 lbs            21-40 lbs               41-80 lbs             81+ lbs
 □ Basic (up to 7 nights)                            $20/night            $22/night            $24/night              $26/night
  2-3 potty walks per day
  End of Stay Report Card
                  A la` Carte`
 □ Spa Package: Bath, blow dry, pedicure                $25                  $35                     $45                  $55
    and cologne
  Pedicure                                                         $5                                        $10

 □ Extra 15 minute play session                       _________ (specify quantity during pet’s stay)            $10/ea
 □ Dog Daycare ($4/hr)                                            4 hrs $16/day  6 hrs $24/day                 8 hrs $32/day
 □ Add Discounted Pre-Paid Dog Daycare Plan to stay ($3.20/hr)                     50 hrs $160                  105 hrs $320
 □ Medication                                                                                                    $8/day
 □ Get my pet’s regular diet from Blylee’s Natural Pet Foods                                                    (prices vary)
 □ Add a toy, bone, chew stick or antler from Blylee’s Natural Pet Food & Supplies                              (prices vary)
 □ Full groom at Classy Critter (by appointment scheduled through them only)
 □ My pet(s) will be receiving veterinary care during their stay
  (Please inform us of any appointments and complete hospital
  authorization forms)

*Charged at rate listed if not on Pre-Paid plan; if on Pre-Paid Plan, hours are deducted from Plan

**On days when daycare is closed = Sundays and Holidays

Please indicate any Pre-existing conditions and/or current areas of concern:


                                                                             Pet’s Name ____________________
                                                                             Owner _________________________

     In the event that a medical issue arises while my pet is in the care of Paws to Play Dog Daycare & Boarding, I
     authorize the Doctors and staff at Pet Medical Center to:

     (Please select one)
     □ Perform whatever treatment the Doctor deems necessary up to $____________. Do not call first for
     authorization. I understand that I will be responsible for the full total of the invoice when I pick up my pet.

     □ Contact me first with an estimated cost, if I am not able to be reached by phone please contact my emergency
     contact list below, they have my permission to authorize or decline treatment.***

     ***If owner or emergency contact is not able to be reached within a reasonable amount of time, the Pet Medical
     Center staff will provide minimal treatment to care for your pet in order to keep that pet as comfortable and
     healthy as possible.***

     Owner Phone Number (where you can be reached):_________________

     Two Emergency Contacts:

              Name _________________________ Phone Number______________________

              Name _________________________ Phone Number______________________

     I agree to pick up my animal at the designated time. Five days from this date, I understand that the animal is
     considered abandoned unless other arrangements have been made. At such time, I relinquish all claims to my
     animal and Pet Medical Center will assume ownership and all rights there unto afforded. I understand that this
     does not relieve me of the responsibility of payment of accumulated hospital and boarding charges.

     ___________________________________                           _____________________________
     Signature of Owner or Agent        Date


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