Name*

First Last

Email*

Phone*

Emergency Contact #1*

First Last

Phone*

Pet Name*

Has your pet stayed with us before?*

Yes
No

Drop off Date*

Drop off Time*

: HH

MM

Please choose a time between 8:30am-11:00am or 2:00pm-5:00pm.

Pick-up Date*

Pick-up Time*

: HH

MM

We provide a house diet for feeding. Do you prefer to bring your own?*

Any food allergies?*

Feeding Directions and Frequency*

Any additional services requested while boarding here?

Exam

If your pet needs an exam while here please answer the following questions.

Concerns

Do you have any other concerns you would like the doctor to address?

Heartworm & Flea Prevention

Please list name of product and date of when it was last given.

Medications

Please provide the name of medication, dosage, and frequency of medication to be given to your pet. All medications must be in their originally prescribed bottle with label. (Additional fee)

Belongings left

Items left with your pet are left at your own risk. We strongly advise labeling your pet's belongings with your last name and pet's name. We would also like to remind all owners we discourage leaving pet bedding. We have beds, blankets and other bedding to help keep your pet comfortable during their stay. Please list below all items that will be left with your pet.

Up to date vaccination record required*

Vaccination records are required prior to boarding stay. We require all pets to be up to date prior to arrival. For Canines they will need proof of Rabies, Distemper Parvo, Bordetella, and Canine Influenza. For Felines they will need Rabies and FVRCP. Please contact us if you have any questions regarding vaccines. If you have read our vaccine requirements, please write "Yes" in box below.

Would you like to add another pet?*

Yes
No

Pet #2

Pet's Name*

Has your pet stayed with us before?*

Yes
No

Drop off Date Request*

Please note this does NOT confirm your request. You will be contacted by staff for confirmation if these dates are available.

Drop off Time*

Please choose a time between 8:30am-11:00am or 2:00pm-5:00pm.

: HH

MM

Pick-up Date*

Pick-up Time*

: HH

MM

We provide a house diet for feeding. Do you prefer to bring your own?*

Any food allergies?*

Feeding Directions and Frequency*

Any additional services requested while boarding here?

Exam

If your pet needs an exam while here please answer the following questions.

Concerns

Do you have any other concerns you would like the doctor to address?

Heartworm & Flea Prevention

Please list name of product and date of when it was last given.

Medications

Please provide the name of medication, dosage, and frequency of medication to be given to your pet. All medications must be in their originally prescribed bottle with label.

Belongings Left

Items left with your pet are left at your own risk. We strongly advise labeling your pet's belongings with your last name and pet's name. We would also like to remind all owners we discourage leaving pet bedding. We have beds, blankets and other bedding to help keep your pet comfortable during their stay. Please list below all items that will be left with your pet.

Please list anyone else authorized to pick up your pet

Emergencies*

Should your pet become ill, the doctors and staff at Animal Clinic of Santa Maria will provide all necessary medical care until we are able to stabilize your pet and reach you. Animal Clinic of Santa Maria is not staffed 24 hours a day. Should your pet need 24 hour assisted care, your pet will be transferred to a 24-hour emergency hospital. Please let us know if you agree or decline.

I agree to pay expenses related to emergency care
I decline any medical treatment

Signature*

Boarding pets are discharged only during regular business hours of Monday-Saturday. I agree to complete payment at the time of discharge. I have read all of the above and I am in full agreement. Please enter your name below as your signature.

First Last

Boarding Contract

Pet #2

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