Canine Boarding - Colorado Springs Vet - Centennial Animal Hospital

Pets Name *

Owner Name *

First

Last

Phone *

Email *

Appointment Date and Time *

Date

Time

What is the best way to reach you while you are away?

Phone
Text
Email

What date and time will you be dropping off your pet? Please note: there are no drop offs on Sunday. Saturdays drop offs must occur between 8 AM - 11:30 AM.. *

Date

Time

What date and time will you be picking up your pet? Please note: there are no pick ups on Sunday. Saturdays pick ups must occur between 8 AM - 11:30 AM. *

Date

Time

Will you be out of the country?

Yes
No

Are you boarding multiple pets? *

Yes
No

How would you like them to be boarded? *

Boarded in individual kennels
Boarded together and share the same kennel (IF under 50 pounds)

I understand that boarding can cause stress which can lead to unpredictable behaviors and there is a risk when kenneling multiple pets together of injury or death. *

I understand the above

Has your pet urinated/defecated already today? *

Is your dog a fence jumper or climber? *

Yes
No

Is your dog a hole digger? *

Yes
No

Is your dog a blanket eater? *

Yes
No

Any known allergies? If yes, please list them below. If none, please write 'N/A': *

Feeding Instructions: *

My pet requires a special diet which I have provided.
Please feed my pet kennel food (Science Diet Sensitive Stomach).

Type of food provided? If not applicable, please write 'N/A': *

Serving size? *

* In cups

Food Schedule *

AM
Noon
PM

Treats/Snacks Schedule

AM
Noon
PM

Will your pet require medications while boarding? *

Yes
No

Medication Name *

How much and how often? *

Would you like to add another medication? *

Yes
No

Medication Name *

How much and how often? *

Would you like to add another medication? *

Yes
No

Medication Name *

How much and how often? *

Special Instructions for Medications *

(Give with food, pill pockets, etc.)

Did you give any medications already today? *

Yes
No

If you did give him or her medications today, what was it and was it given? *

Special Instructions *

(Doesn’t like to be picked up, is blind/deaf, etc.)

Pet Belongings (not accepting bowls, beds, blankets/bedding or toys requiring supervision.) *

Exercise Instructions (including contact with other dogs) *

I do not want my dog to be exercised outside the hospital during it’s boarding stay.
My dog may be taken outside on a leash only.
My dog may be taken outside without a leash, and I understand the fence is only 5 feet tall.

My dog is good with other dogs and can have contact with other dogs: *

Yes
No

Sex *

Male
Female

Additional Optional Boarding Services

Extra Walk - $20 each
Pack Yard Time - $15
Solo Yard Time - $20

Pets are taken out multiple times throughout the day and evening. Plus we now come back and do a last potty break before bedtime.

Extra Walk - How Often? *

Daily
Every other day
Midway through stay

Pack Yard Time - How Often? *

Daily
Every other day
Midway through stay

Solo Yard Time - How Often? *

Daily
Every other day
Midway through stay

Are we your primary Veterinarian? *

Yes
No

Primary Veterinarian's Name *

Primary Veterinarian's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Veterinarian's Phone *

Required vaccines must be given 48 hours before boarding:

Rabies
Distemper/Parvo
Bordetella

Does your pet meet all the boarding requirements? *

Yes
No

Please attach proof of your pets vaccines.

Click or drag a file to this area to upload.

General Boarding Requirements: All pets staying at Centennial Animal Hospital must have up-to-date vaccinations, including Rabies and FVRCP. If your cat is allowed outdoors, then an FeLV vaccine will be required. You must have a negative FeLV/FIV test on record with us. If you received those vaccines or tests elsewhere, you must bring proof before boarding with us. In addition, all pets must be free of fleas and ticks. If fleas or ticks are detected at any time during your pet’s stay with us, they will receive a Frontline treatment at the owner’s expense. *

I have read and understand.

Notice of No Staff on Premises: We do not have staff on the premises 24 hours a day, 7 days a week. While your pet is boarding with us, there is no one on the premises after hours and on weekends for your pet's direct supervision. Staff does come in for feeding/walking and husbandry throughout the day/evening. *

I have read and understand.

Boarding drop off and picks up are still performed curbside. Please call to let us know you have arrived. Please have your dogs on a leash. *

I have read and understand.

Medical Policy: If your pet becomes ill while boarding, as determined by the trained staff, they will reach out to one of our veterinarians to determine appropriate care deemed necessary. Every effort will be made to contact the owner to inform them of the situation. If your pet requires treatment for their comfort and safety and we are unable to contact you or your emergency contact, treatment will be provided, and you will be responsible for the fees incurred. It is explicitly understood that if you (the owner) choose to seek medical care for any condition or complication of medical care initially received at Centennial Animal Hospital, you will assume full financial responsibility. *

I have read and understand.

Abandoned Pets: Pets that are left three days beyond their specified discharge date, without notification to Centennial Animal Hospital, shall be considered abandoned and shall become the property of Centennial Animal Hospital. If we are unable to contact you, Centennial Animal Hospital will make arrangements for placement or humane care, including possible euthanasia if necessary. By initialing, you agree to be responsible for all fees incurred, including administrative costs, court costs, and attorney fees necessary to collect on the account. *

I have read and understand.

Contact with Other Dogs: You agree that your pet is not dog aggressive and can have contact with other dogs during outside exercise time. This will be supervised time in a fenced yard (the fence is 5 feet tall). Fence jumpers are not allowed this option, and you understand the possibilities of injury or loss during this activity. If any dog(s) acts out of character or unpredictably and my dog is injured or escapes from the fenced yard, I agree to not hold Centennial Animal Hospital agents or staff liable in any way for these unforeseen acts. If loss or injury occurs, we will attempt to contact the owner. If we are unable to contact the owner, you authorize medical or surgical treatment if needed to provide for your dog's safety and comfort and agree to pay for any fees that may result.

I have read and understand.

Boarding Consent: I have read and understood the above-listed requirements. I acknowledge that Centennial Animal Hospital Boarding Kennel is not staffed 24 hours a day. I understand that reasonable precautions will be used against injury, escape, or death. Centennial Animal Hospital and its staff will not be held liable provided reasonable care and precautions are followed. I understand that any charges incurred will be paid in full at the time of release. Unpaid balances are subject to collection costs, including late payment fees, court costs, and attorney’s fees. *

I have read and understand.

Emergency Contact *

First

Last

Phone *

Owner's Signature *

Date *

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Canine Boarding Agreement

Canine Centennial Animal Hospital Boarding Agreementent

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