700 Innovation Drive Kingston, Ontario K7K 7E7 Tel (613) 544-PETS (7387) Fax (613) 544-9150 www.barriefieldanimalhospital.com
BOARDING HISTORY FORM
CLIENT INFORMATION:
OWNER/GUARDIAN: ______________________________________________________ HOME ADDRESS: __________________________________________________________ CITY/PROV/POSTAL CODE: ________________________________________________ HOME PHONE #: ___________________ CELL/WORK PHONE #: _______________
PET INFORMATION:
PET’S NAME: ________________________ BREED: _____________________________ SEX: MALE FEMALE SPAYED/NEUTERED AGE: ___________ COLOUR/MARKINGS: ____________________________________________ CURRENT VET: __________________________________________________ VACCINATIONS: RABIES _______ DHPP/FVRCP _______ BORDETELLA ________ HEALTH CONCERNS/ALLERGIES/RECENT SURGERY: __________________________ MEDICATIONS/SUPPLEMENTS: _______________________________________________ CURRENT DIET BEING FED: __________________________________________________ FEEDING INSTRUCTIONS: ____________________________________________________ ITEMS BROUGHT IN FOR BOARDING: FOOD: ___________ BEDDING: ____________ TOYS: _____________________ LEASH: __________________ OTHER: _______________
EMERGENCY CONTACT INFORMATION:
NAME: ________________________________ PHONE #: ____________________________
IN THE EVENT THAT YOUR PET BECOMES ILL OR INJURED, EVERY EFFORT WILL BE MADE TO CONTACT THE OWNER AND ABOVE EMERGENCY CONTACT PERSON (IF OWNER N/A) FOR INSTRUCTIONS REGARDING EXTENT OF CARE. IF VETERINARY CARE IS DEEMED ADVISABLE, OWNER WILL HAVE THE VETERINARY FEES ADDED TO THEIR INVOICE/BILL. IN THE EVENT THAT WE ARE UNABLE TO CONTACT THE OWNER/EMERG CONTACT PERSON, THEN BARRIEFIELD ANIMAL HOSPITAL WILL PROCEED WITH ANY MEDICATIONS/TREATMENTS THAT WE FEEL IS NECESSARY FOR THE BEST INTEREST OF YOUR PET. I, THE UNDERSIGNED, UNDERSTAND & ACKNOWLEDGE THE ABOVE STATEMENTS/AGREEMENT _____________________________________________________________ DATE: _________________________
BOARDING HISTORY FORM BOARDING RATES:
CANINE: SMALL KENNEL – 25.00 MEDIUM KENNEL – 28.00 LARGE KENNEL – 32.00 **THERE IS A DISCOUNT APPLIED TO SECOND DOG IF BOARDED TOGETHER IN SAME KENNEL** FELINE: CAT CONDO – 18.00 **THERE IS A DISCOUNT APPLIED TO SECOND CAT IF BOARDED TOGETHER IN SAME KENNEL** *THERE IS A SURCHARGE APPLIED PER DAY IF YOUR PET IS REQUIRING MEDICATIONS TO BE GIVEN WHILE IN BOARDING…5.00/DAY DURING WEEK 10.00/DAY DURING WEEKEND*
**AFTER 9 NIGHTS STAY…GET THE 10TH NIGHT FREE!!!** BOARDING DATES:
ARRIVAL DATE/TIME: _________________________________________________________________ PICK UP DATE/TIME: __________________________________________________________________ OWNER/GUARDIAN CONTACT INFO: __________________________________________________ ARRIVAL DATE/TIME: _________________________________________________________________ PICK UP DATE/TIME: __________________________________________________________________ OWNER/GUARDIAN CONTACT INFO: __________________________________________________ ARRIVAL DATE/TIME: _________________________________________________________________ PICK UP DATE/TIME: __________________________________________________________________ OWNER/GUARDIAN CONTACT INFO: __________________________________________________ ARRIVAL DATE/TIME: _________________________________________________________________ PICK UP DATE/TIME: __________________________________________________________________ OWNER/GUARDIAN CONTACT INFO: __________________________________________________ ARRIVAL DATE/TIME: _________________________________________________________________ PICK UP DATE/TIME: __________________________________________________________________ OWNER/GUARDIAN CONTACT INFO: __________________________________________________ ARRIVAL DATE/TIME: _________________________________________________________________ PICK UP DATE/TIME: __________________________________________________________________ OWNER/GUARDIAN CONTACT INFO: __________________________________________________ ARRIVAL DATE/TIME: _________________________________________________________________ PICK UP DATE/TIME: __________________________________________________________________ OWNER/GUARDIAN CONTACT INFO: __________________________________________________