"*" indicates required fields Client InformationPet Name* Client Name* Phone Number*Email* Emergency Contact Name Phone NumberBoarding InstructionsBoarding From* MM slash DD slash YYYY Boarding To* MM slash DD slash YYYY Would You like Additional Play Sessions? Yes No (See Pricing Sheet for cost details)Feeding InstructionsHow many cups?* How many times a day?* What type of food?* Owner Food Clinic Food Special Diet Special Diet* Yes No If yes, what kind?* Medication InstructionsNameDosing Instructions Add RemoveWould you like a bath on departure? Yes No (See Pricing Sheet for cost details)Boarding ConsentAll animals must be current on all vaccinations. If not, he/she will be given the necessary vaccines at the clients’ expense. (Dogs – Rabies, DHPPV, Bordetella, Fecal, 1st and 2nd Flu Vaccine and Cats – Rabies, FVRCP, Fecal).* All animals must be current on all vaccinations. If not, he/she will be given the necessary vaccines at the clients’ expense. (Dogs – Rabies, DHPPV, Bordetella, Fecal, 1st and 2nd Flu Vaccine and Cats – Rabies, FVRCP, Fecal).* I understand that while my pet is fully vaccinated, that vaccines are not guaranteed and there is a risk that my pet(s) may contact a contagious disease or illness. I agree that should this occur, I am responsible for my own pet’s care, medication attention and costs.* I understand that while my pet is fully vaccinated, that vaccines are not guaranteed and there is a risk that my pet(s) may contact a contagious disease or illness. I agree that should this occur, I am responsible for my own pet’s care, medication attention and costs. * All animals must be microchipped. If not, Birmingham Animal Hospital + Resort will provide this service at the clients’ expense.* All animals must be microchipped. If not, Birmingham Animal Hospital + Resort will provide this service at the clients’ expense. * All animals must be free of external parasites (ex. Fleas, ticks, etc) or they will be treated at clients’ expense.* All animals must be free of external parasites (ex. Fleas, ticks, etc) or they will be treated at clients’ expense. * We do offer a socializing atmosphere with group play. Every precaution is taken to ensure the safety of your pets. However, problems may arise that we may not foresee. In the event your pet needs to be seen by the hospital, we will make every effort to contact you. Please let us know if you would not like your pet to socialize with others.* We do offer a socializing atmosphere with group play. Every precaution is taken to ensure the safety of your pets. However, problems may arise that we may not foresee. In the event your pet needs to be seen by the hospital, we will make every effort to contact you. Please let us know if you would not like your pet to socialize with others. * *Birmingham Animal Hospital + Resort has my permission to treat _____ should an emergency arise.* Yes No Charges will be billed to your account accordingly.Pet Name* I give my permission for my pet to play in Birmingham Animal Hospital + Resort’s pool. I will not hold Birmingham Animal Hospital + Resort liable for any illness or injury that may result from this.* I give my permission for my pet to play in Birmingham Animal Hospital + Resort’s pool. I will not hold Birmingham Animal Hospital + Resort liable for any illness or injury that may result from this. * Birmingham Animal Hospital + Resort does not recommend bringing personal items from home as they may get lost in the laundry or soiled. Birmingham Animal Hospital + Resort is not responsible for any lost or damaged personal items.* Birmingham Animal Hospital + Resort does not recommend bringing personal items from home as they may get lost in the laundry or soiled. Birmingham Animal Hospital + Resort is not responsible for any lost or damaged personal items. * If your pet is not called for within 14 days after the designated checkout time, the pet will be considered abandoned and will be handled in accordance with state law. All adoption fees and other incurred expenses will be the responsibility of the owner.* If your pet is not called for within 14 days after the designated checkout time, the pet will be considered abandoned and will be handled in accordance with state law. All adoption fees and other incurred expenses will be the responsibility of the owner. * Do you opt IN/OUT to allow your pets run to be furnished?* Opt In Opt Out I (the pet owner) opt IN to allow my pets run to be furnished and understand that I (the pet owner) will be held financially responsible for any damages made to the furniture, rugs, or beds in the boarding area during my pets stay.* InitialI (the pet owner) opt OUT to allow my pets run to be furnished and understand that I (the pet owner) will be held financially responsible for any damages made to the furniture, rugs, or beds in the boarding area during my pets stay.* InitialAuthorizationSignature Reset signature Signature locked. Reset to sign again Date MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.
