Boarding Release / Agreement Form

All required fields are marked {*}

Pet Owner's Name*
First Last
Pet Owner's Email*
Pet's Name*
Boarding Drop-Off Date*
MM slash DD slash YYYY
Boarding Pick-Up Date*
MM slash DD slash YYYY
I hereby authorize and direct the veterinarians and staff of Goose Creek Pet Hospital to board my pet during the above dates. I certify that my pet is free of external parasites and contagious disease at presentation to the best of my knowledge. I further understand that if my pet requires medical attention for any reason, as determined at the discretion of Goose Creek Pet Hospital's staff, I will assume full financial responsibility for that care. Goose Creek Pet Hospital has my permission to make health care decisions on behalf of my pet(s). I understand that Goose Creek Pet Hospital and staff will not be liable for any problems that develop, provided that reasonable care and precautions are followed, and I hereby release them of any liability of any kind whatsoever arising from my pet(s) boarding.*
I agree and authorize
Please list any Medications and Instructions. (If None, please say None).*
Please list Feeding Instructions*
Please list any bedding or medical concerns we should be aware of. (If None, please say None).*
Emergency Contacts
Emergency Contact #1 Name*
First Last
Emergency Contact #1 Phone*
Emergency Contact #1 Alternate Phone
Emergency Contact #2 Name
First Last
Emergency Contact #2 Phone
Emergency Contact #2 Alternate Phone
Signature of Owner or Responsible Agent. (By signing this form, I acknowledge that I have read and understand all of the above information and agree to the terms).*
Name of Owner or Responsible Agent*
First Last
Date Completed:*
MM slash DD slash YYYY
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Name
This field is for validation purposes and should be left unchanged.

Boarding Release / Agreement Form

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