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					                                                  PET INFORMATION
  (1) SPECIES:            NAME:                                   BREED:                               COLOR:
                  SEX:            FIXED:           DOB:

  (2) SPECIES:            NAME:                                   BREED:                               COLOR:
                  SEX:            FIXED:           DOB:

  (3) SPECIES:            NAME:                                   BREED:                               COLOR:
                  SEX:            FIXED:           DOB:

MY PET CAN BE SUMMED UP AS (check all that apply)
 ( ) QUIET, ( ) SHY, ( ) FEARFUL, ( ) FRIENDLY, ( ) NOISY, ( ) BITER,
  ( ) ESCAPIST ( ) FENCE CLIMBER, ( ) PROTECTIVE, or ( ) OTHER
MY PET IS AGGRESSIVE WITH (check all that apply)
( ) ADULTS, ( ) CHILDREN, ( ) ANIMALS, or ( ) OTHER

MEDICAL INFORMATION (check all that apply)
MY PET IS/HAS ( ) BLIND, ( ) OLD, ( ) DEAF, ( ) DIABETIC, ( ) ARTHRITIC,
( ) EPILEPTIC, ( ) SKIN PROBLEMS, ( ) EAR PROBLEMS, ( ) OTHER
FOOD ALLERGIES:
MEDICATION MY PET IS ON:
TYPE:                                      AMOUNT GIVEN:
TYPE:                                      AMOUNT GIVEN:
*Misawa Pet Kennel and its staff can’t be responsible for any known medical history no listed above*

FEEDING INSTRUCTIONS:




ADDITIONAL COMMENTS:



                                           OWNER INFORMATION (please print)
RANK & NAME:                                                                        BOX #:
SSN: xxx-xx-                  ORG/UNIT:                                    DEROS:
DUTY PHONE:                         HOME/CELL PHONE:
EMAIL ADDRESS:




  1 April 2010                    Please Submit Completed Forms to Misawa.petkennel@misawa.af.mil               1
                                EMERGENCY CONTACT INFORMATION (Only 1 is required)


1. NAME & RANK:
             DUTY PHONE:                    HOME/CELL PHONE:


2.       NAME & RANK:
             DUTY PHONE:                    HOME/CELL PHONE:


3.       NAME & RANK:
             DUTY PHONE:                    HOME/CELL PHONE:


4. NAME & RANK:
             DUTY PHONE:                    HOME/CELL PHONE:


5. NAME & RANK:
           DUTY PHONE:              HOME/CELL PHONE:


6. NAME & RANK:
           DUTY PHONE:              HOME/CELL PHONE:



        IN THE EVENT THAT THE KENNEL PERSONNEL ARE UNABLE TO CONTINUE BOADING MY PET FOR ANY REASON, MY
         EMERGENCY CONTACT WILL COME AND PICK UP MY PET FROM THE FACILITY. I WILL STILL BE LIABLE FOR ALL
         THE BOARDING FEES ACCRUED UP TO THE POINT MY PET LEAVES THE FACILITY.

        THE ABOVE EMERGENCY CONTACT(S) HAS BEEN NOTIFIED.


     SIGNATURE:



        MY EMERGENCY CONTACT(S) IS AUTHORIZED TO DROP-OFF AND/OR PICK-UP MY PET(S).


     SIGNATURE:




     1 April 2010               Please Submit Completed Forms to Misawa.petkennel@misawa.af.mil             2
                                           AGREEMENT TO HOLD HARMLESS WAIVER AND ASSUMPTION OF RISK


 All pets must be registered at the Misawa Vet Clinic and be implanted with a microchip in order to be boarded.
 If my pet is stolen or passes away the kennel will only reimburse boarding fees. If I desire more I must arrange for private insurance at my cost. In no
     way will the kennel or its employees be held liable for the death of my pet due to illness or treatment.
 A deposit equal to 3 days boarding for each pet is required with all reservations. Final payment is due before release of the pet. I must cancel up to
     three days prior to the reserved drop-off date for a FULL refund (Holidays and Sundays are not included in the counting of 3 days). Anytime
     after three days prior, I will lose my deposit.
 Malicious pets will not be boarded. Determination will be at the discretion of the kennel personnel. Also, pets within two weeks of giving birth or that are
     due during the prospective boarding periods will not be accepted.
 All arrangements for baths must be requested in advance; however it is highly recommended that all pets boarding for any length of time receive
     at least a kennel bath prior to pick-up.
 I will not hold the kennel responsible for items that I chose to leave with my pet. We recommend that all items (to include leashes, blankets, toys,
     clothes, and bowls) be taken with you after check in or left at home. Due to possible soiling, chewing, and mix-up we cannot guarantee the return of
     these items.
 I must provide proof that my pet(s) have current vaccinations (less than 1 year). Boarding will be refused if proof is not shown. Current print out from
     the vet clinic with your pets name will be sufficient, rabies tags are not considered proof.
             Dogs: rabies, canine distemper, and kennel cough vaccinations.
             Cats: rabies and feline distemper vaccinations.
 Current vaccinations are required for any service the pet kennel provides.
 If my pet becomes ill and/or requires medical attention, I will be liable for all costs incurred, to include charges by an off-base veterinarian or an
     emergency military veterinarian. I authorize the kennel personnel access to my pet’s medical records and allow them to take my pet to any clinic for all
     treatment deemed necessary.
 All pets boarding at the Misawa Boarding Facility must be free of external parasites, and be on some type of flea and tick prevention. The kennels will
     not be held responsible for any fleas and ticks found on my pet.
 If I am boarding more than one pet per kennel and they are not getting along, or neither of the pets is fixed and the female is in heat, kennel personnel
     will separate them and I will be charged for each kennel. The kennel will not be held responsible for female pets becoming impregnated.
 I must notify the kennels prior to the date of scheduled pick up if my pet needs to be boarded for a longer period than expected. Extension of boarding
     without notification will result in additional fees of $5.00 a day per pet.
 I must supply adequate food and medication for the duration of my pets stay. If the supply becomes inadequate, the kennel personnel will supply my
     pet(s) with food and the fees will be added to the boarding stay. Medications will only be administered as prescribed by a veterinarian.
 My emergency contact will be contacted to remove my pet(s) in the event the kennel is unable to continue boarding for any reason. I will still be liable for
     all boarding fees up to the point my pet leaves the premises.
 The kennel personnel are responsible for the health and safety of the pets boarded so my pet(s) will not leave the kennel premises for the duration of
     their stay without prior approval. Only those individuals authorized can sign-out my pets from their kennel. Designated persons must be listed as an
     emergency contact.
 PCS’ING families needing transportation to or from the airport, TLF, or vet clinic must make arrangements 72 hours prior.
 All pets must be leashed or in a carrier when bringing them into the kennel.
 Any pet left more than 30 days past reserved pick-up date without notification to the kennel staff will be put up for adoption. I understand that I will still
     be liable for all costs incurred up until the point the pet leaves the facility.
 Misawa Pet Kennel maintains staff on the premises from 0600-1800 Monday-Saturdays and for six hours on Sundays and Holidays. All other hours’
     pets are left in the facility by themselves.
 Misawa Pet Kennel is aware of any possible limitations my pet(s) may have and I hereby release them from any responsibility for anything that may
     happen should I neglect to disclose a known medical problem.
  Visitation is limited to our daily operating hours: Monday-Saturday 1000-1800. Anyone dropping off or picking up during non-business hours will be
     charged a fee of $35.00 per pet fee each time; however for those personnel on orders PCS’ing out the fee will be waived if pick-up is between 0600-
     0800 Monday-Saturday, excluding Sundays and holidays.
 I understand that boarding my pet(s) is not without risk. I also hereby waive and release the Misawa Boarding Facility, its employees, owners, and agents
     from any and all Liability my pet or I may suffer. My signature below states that I have read and understand the Agreement to Hold Harmless Waiver
     and Assumption of Risk.

   1 April 2010                                 Please Submit Completed Forms to Misawa.petkennel@misawa.af.mil                                                    3
Print Name & Sign:                                                    DATE:            \




 1 April 2010        Please Submit Completed Forms to Misawa.petkennel@misawa.af.mil       4

				
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