Boarding Release Form Name of the owner First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency contact name*Emergency phone number*Email Please be aware that in the event of an emergency and the above contact us unreachable; care will be provided by our staff at owner’s expense.Pet's name*Age*Sex* Male Female Spayed NeuteredColor*Weight*Suite/Run*Species* Canine Feline Breed*Add another pet?* Yes NoPet's name*Age*Sex* Male Female Spayed NeuteredColor*Weight*Suite/Run*Species* Canine FelineBreed*Add a third pet?* Yes NoPet's name*Age*Sex* Male Female Spayed NeuteredColor*Weight*Suite/Run*Species* Canine FelineBreed*Is your pet aggressive towards other pets?* Yes No Not SureIs your pet aggressive towards people?* Yes No Not SureIs your pet fearful or head shy?* Yes No Not SureEast York Veterinary Center asks that all clients bring their pets current food for them to eat while boarding with us. This helps reduce the risk of GI issues, which can occur from any sudden change in diet. East York Veterinary Center can provide Science Diet Adult dog and cat food, as applicable, for a nominal fee. In the event that your pet has diarreah while boarding with us we will switch them to a bland diet, such as canned Hill's i/d, for which you would be charged per can used.*(Owner Initials)Please list any items that you have brought for your pet while they are boarding with us. While we do try our best to care for these items, we cannot be held responsible for the loss of or any damage to these items while your pet is in our care.*Please list all current medications that your pet is on. Our medical-staff will be responsible for any and all medications administered while your pet is in our care. A fee of $3 a day is charged for this service.*EXTRA HANDLING: If your pet requires extra handling or extra staff there will be associated additional fees.*(Owner Initials)FLEAS: If your pet is not on a purchased flea product and contracts fleas while or after boarding, East York Veterinary Center cannot be held accountable. If fleas are found on your pet, either upon admittance, or while boarding, they will be treated at your expense; this is non-negotiable.*(Owner Initials)Additional Services Nature Walk Snuggle Time Playtime Tasty Treat Tail Wagging Toy Treat Tire/Kong Bedtime Service Pet PostcardAdditional Services are 3/$15 or 6/$25Additional Services (Feline) Kitty Climbing Wall Snuggle Time Playtime Catnip Toy and Sprinkle Coat Brushing Catch of the DayOther Services Tooth Brushing Nail Trim Spa PackageAdditional fees may applyI have read and understand that there are additional fees associated with extra services requested, medication dispensing, dietary restrictions and destructive behavior. I also have read and understand EYVC's policy of no refunds for early pick-ups. I am aware of the boarding drop-off and pick-up hours and I accept and understand that I will be charged an additional day's boarding for early drop-off or late pick-ups.*(Sign here)Δ
