Boarding And Daycare Agreement - Ruffners Luxury Pet Boarding (Page 2 of 4) in pdf

Boarding And Daycare Agreement - Ruffners Luxury Pet Boarding Page 2

If yes please explain:

________________________________________________________________________

MEDICAL EMERGENCY INFORMATION

Veterinarian Name/Clinic:_________________________ Phone:___________________

Address: _________________________ City:_______________ State: ______ Zip:__________

VACCINATIONS:

Please list the most recent date of the following vaccinations

DOGS

Rabies:________________________________ Negative Stool Sample:____________________

DHLPPC/ Distemper, Hepatitis, Lepto, Parvo, Parafluenza & Corona: _____________________

Bordet Ella (Kennel Cough Vaccine): _______________________________________________

CATS

Rabies:________________ Distemper: ________________ Rhinotrachetis:_________________

Leukemia: ____________________________________________(Recommended, not Required)

Canine Bordetella Vaccine must be given at least 10 DAYS prior to first

boarding stay and MUST BE given every year, although every 6 months

is highly recommended.

Please describe any medical or physical problems:_____________________________________

______________________________________________________________________________

Emergency Medical Care. If, in our judgment, your pet requires medical care

and we are unable to reach you, or your emergency contact, please indicate

whether you want us to take your pet to a veterinarian or animal hospital.

** YOU MUST CHECK EITHER “YES” OR “NO” FOR THIS FORM

TO BE VALID**

 YES By checking “YES” you agree to be solely responsible for the payment of all medical

bills for your pet and you release Ruffner’s Luxury Pet Boarding inc, its officers, directors,

agents, and employees of and from any and all responsibility for, claims, damages, debts, arising

out of or related to such medical care, including, but not limited to, transportation to/from the

veterinarian clinic and choice of veterinarian hospital.

 NO By checking “NO” you agree to release Ruffner’s Luxury Pet Boarding inc, its officers,

directors, agents, and employees of and from any and all responsibility for, claims, damages,

Boarding And Daycare Agreement - Ruffners Luxury Pet Boarding Page 2