Feline Boarding Agreement

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Arrival Date:
Pick Up Date:

Your Name:
Address:
City:
State:
Zip:
Email Address:
Home Phone:
Cell Phone:

Emergency Contact:
Phone:
Name of people authorized to drop off/ pick up your pet:


Pet Information

Pet Name:
Breed:
Age:
Color:
Weight:
Sex:

Veterinarian:
Address:
Phone:


Feeding Instructions

Name of food or hospital diet:
Quantity:
Frequency:
Wet:
Dry:
Mix:
Dry with water:
Allergies:
Food Restrictions:
Is it ok to give your cat treats?
Last Feeding: Date:
am:
pm:


Medical Information

Vaccination Policy
To prevent the spread of disease while your pet is in our care, cats must be current on Rabies, FVRCP and Feline Leukemia for outdoor cats. It is the responsibility of the client to provide proof of vaccination history for each animal boarding. The vaccinations must be administered by a Veterinarian. Animals whose shots are not up to date must be vaccinated by Ashburn Village Animal Hospital prior to admittance and at the owner's expense or they will not be allowed to board.

Is your pet on any medication?

Medication Name Frequency Quantity Last Does Given


Special Instructions for administering medications?
Any Medical / Health concerns?

Medical Illness Policy
One of the advantages of boarding your pet(s) at a veterinary hospital is that medical attention is readily available should the need arise. Should your pet become ill or is injured we will call the emergency numbers regarding your pet's symptoms, treatment options and an estimate of additional costs. However, if the owner or their authorized agent cannot be reached, please indicate your wishes below, should your animal require treatment to relieve immediate discomfort or resolve an important medical condition. If it will be difficult to reach you during your pet's stay at Ashburn Village Animal Hospital, please provide us with the names and phone numbers of persons authorized to act as your agent during your pet's stay.

Please perform whatever services the doctor deems necessary for the best care of my pet until I or my authorized agent can be reached. I authorize up to the following amount:

$100.00
$250.00
$500.00
Other Amount:

Initials


Do not administer any medical treatment until specific authorization is given by the owner or their authorized agent.

Initials


I hereby authorize the following person(s) to act as my agent(s) should the need for medical care arise during my pet's stay at Ashburn Village Animal Hospital and I am unable to be reached. I understand that I shall be fully responsible for any medical care authorized by either myself or any authorized agent:

Initials

Name:
Phone:
Name:
Phone:


General Information

Has your cat ever exhibited aggressive behavior with:

People:
Other Cats:


If yes, please explain:
Is there anything in particular that frightens your cat?


Please share any additional information that may be helpful to our staff in providing the best possible care and enjoyable stay for your pet while at Ashburn Village Animal Hospital:


 

Disclaimers and Additional Provisions
(1) Standard precautions will be used against the injury, escape, or death of this pet. The clinic and staff will not be held responsible for illnesses or injuries that occur, provided standard care and precautions have been followed as determined at the sole discretion of Ashburn Village Animal Hospital. .
(2) Owner understands and agrees that the Owner is solely responsible for any harm caused by Owner’s pet(s) while attending Ashburn Village Animal Hospital. Owner further understands and agrees that in admitting Owner's pet to Ashburn Village Animal Hospital all health and behavior problems have been fully disclosed to the best of owner’s knowledge. A $10 / per day handling charge will be assessed for any aggressive animals.
(3) Owner fully understands that any health, behavior or injury problems that develop during their pet's stay at Ashburn Village Animal Hospital will be handled and treated as deemed appropriate by the employees at Ashburn Village Animal Hospital and Ashburn Village Animal Hospital and owner agrees to assume full financial responsibility for any and all expenses arising from or relating thereto, subject to the stipulations set forth in the Medical / Illness policy above. In no event shall Ashburn Village Animal Hospital or Ashburn Village Animal Hospital be liable for illnesses that arise during Owner's pet's stay or after Owner's pet has left the facility.
(4) Owner understands and agrees to the charges for boarding at Ashburn Village Animal Hospital. Pick up time for boarding patients is 3:00pm of the last day of the scheduled stay.  Any boarding pets picked up after 3:00pm will be subject to an additional charge equivalent to one day of boarding.

 

(5) All charges incurred by the Owner under this agreement shall be due and payable in full upon pick up of the pet. Owner agrees that the pet shall not leave Ashburn Village Animal Hospital until such time as all charges incurred by the Owner have been paid in full to Ashburn Village Animal Hospital. In addition, Ashburn Village Animal Hospital is hereby granted by Owner a lien on the pet for any and all unpaid charges resulting from boarding pet at Ashburn Village Animal Hospital. Owner hereby agrees that in the event that all charges incurred under this contract are not paid when due, Ashburn Village Animal Hospital may exercise its lien rights upon ten days written notice sent by certified mail, return receipt requested, to Owner at the address shown on this contract. Ashburn Village Animal Hospital may dispose of pet for any and all unpaid charges, at public or private sale or by turning pet over to the nearest humane society or animal shelter. If such sale shall not secure sufficient funds to pay for all charges incurred under this contract, then Owner shall be liable to Ashburn Village Animal Hospital for the difference. All monies realized by Ashburn Village Animal Hospital at such sale, over and above the charges incurred under this contract and the costs of sale, shall be paid by Ashburn Village Animal Hospital to Owner.

I have read, understand and agree to all provisions of the above agreement. I fully intend to pick up my pet on the above specified date.

If circumstances change I will notify Ashburn Village Animal Hospital of the new pick up date and assume responsibility for any additional charges incurred.

Date:
Signature:

 

 

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Emergency Info

In case of emergency contact:

Hope Center
Vienna,VA
703-281-5121

The Life Center
Leesburg, VA
703-777-5755