Name *

First

Last

Email *

Phone *

Emergency Contact *

First

Last

Emergency Contact Phone *

Name of Pet(s) *

Drop Off Date: *

Please fill out this form after you have a confirmed reservation to board your pet.

Pick Up Date *

Estimated Pick Up Time *

Please list any items you choose to leave:

We do not recommend leaving personal items for your pet and are not responsible for them.

Food Options while boarding *

House food (Hills Science Diet - GI)
Your Own Food

Name of food and feeding instructions:

Will your pet need to receive medications while boarding? *

No
Yes

Additional $9.00/day for oral or topical meds and an additional $49.00 per day for injectable meds/after hour nursing care. NOTE: All medication must be in original RX bottle and identified to ensure proper dosing and to prevent under and/or over dosing of medication. Please do not place medication in food to be dispensed with food.

Please list medications:

Would you like for your pet to receive a bath? *

Yes, I want my pet to have a bath by kennel staff for additional fees.
Yes, I want my pet to have a Free bath by kennel staff AFTER 5 DAYS OF BOARDING.
No. I do not want my pet to receive a bath.

Would you like for your pet to receive daily doctor checkups? *

Yes. I understand I will be charged an additional $25 a day.
No

Additional $25 fee.

Is there anything else you would like to relay to the staff about your pet?

Has your pet been diagnosed with any severe health issues within the last 90 days? Please list. *

Is your pet agressive toward other animals? *

Yes
No

Has your pet ever escaped a kennel unit? *

Yes
No

In order to board, your pet must be current on vaccinations and a fecal exam. This protects your pet from diseases that are easily transmitted.

Required vaccinations:

DOGS - Canine Influenza (including booster), Rabies, DA2PPv - within the last 12 months. Bordetella and a negative fecal test within the last 6 months.

If your pet is not current the required vaccinations/fecal test will be administered at arrival. *

Yes. I authorize the staff to administer required vaccinations at an additional cost.
No. My pet is current on vaccinations.

Please note that any vaccine administered will also require an exam with an exam fee.

Please list where the vaccinations were given:

If you have a copy of your vaccinations, you can also upload them below:

Drag & Drop Files, Choose Files to Upload

ATTENTION (Please read and check below to acknowledge you agree to these terms):

If my pet were to become ill while boarding and the staff were unable to contact me by the numbers listed above, I authorize Animal Care Center of Carters Creek to perform necessary treatments for the health, safety, or well-being of my pet while under their care. I understand that this will be at my expense and that payment will be due at the time of discharge.

If my pet should injure itself in any escape attempt, refuse food, become ill, or become deceased while in their care, I will not hold the doctors, staff, or Animal Care Center of Carters Creek responsible or liable, except in the presence of gross negligence.

If I neglect to pick up my pet by the end of my contracted agreement and/or do not provide any written or verbal extension of the agreement, after 10 days from the agreed pick up date, Animal Care Center of Carters Creek may assume that the pet has been abandoned and will become property of Animal Care Center of Carters Creek to be rehomed, turn over to a rescue/humane society, or in special cases euthanize. I understand that abandonment does not release me from my obligation for full payment of the bill.

I authorize Animal Care Center of Carters Creek to use my pet's photo in professional social media and advertising.

If my pet is found to have fleas/ticks or intestinal parasites while boarding, I authorize Animal Care Center of Carters Creek to provide appropriate treatment at additional cost.

Acknowledgement of Terms *

I agree to the Terms above

Date Completed *

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