Boarding Check-In Form START NOW 7 Boarding Check-In Form Please complete our Boarding Check-In Form. All fields marked with * are required and must be filled. Pet's Name(Required) Client's Name(Required) First Last Phone(Required)Email(Required) Emergency Contact's Name(Required) First Last Emergency Contact's Phone(Required)Boarding times are based on a 1/2 day schedule (2 p.m. check-in/check-out,) with the exception of Sunday, which is a full day.Arrival Date MM slash DD slash YYYY Departure Date MM slash DD slash YYYY I will drop my pet off:(Required) Before 2 p.m. After 2 p.m. Drop Off Time(Required) Hours : Minutes AM PM AM/PM I will pick my pet up:(Required) Before 2 p.m. After 2 p.m. Pick Up Time(Required) Hours : Minutes AM PM AM/PM We will not release the pet to anyone other than the owner without prior consent. All pets must be picked up within 5 days of the specified check-out date. All efforts will be made to contact the owner/agent. Failure to respond or pick up a pet will result in the facility protocol for abandoned animals.Name and Number of Authorized Person Name and Number of Authorized Person Name and Number of Authorized Person Species(Required)CanineFelineApproximate Weight(Required) Appetite(Required)Healthy AppetitePicky EaterFood Choice(Required)Owner-suppliedHospital-suppliedFeedings Per Day(Required) Amount Per Feeding(Required) Any Special Feeding Instructions (List any additional food/treats here)Any known allergies (Please list)If your pet requires vaccines, an exam may be required. If your pet requires medications, additional treatment or services, please allow extra time for check-in. Additional charges may apply.VACCINATIONS MUST BE CURRENT for boarding any cats or dogs. As the owner, you are responsible for all related charges. If you are not a regular client of our hospital, please bring proof of vaccinations.(Required) I agree that all required vaccinations will be given to my cat/dog if overdue, including Rabies, Feline or Canine Distemper, and Kennel Cough for dogsIs your pet on any medications?(Required) Yes No List Medications (Name, Dose, Frequency)(Required)I understand that controlled substances may not be brought into the building and if my pet is on a controlled substance they can not board at this facility.(Required) I have read and understandI understand I must bring medication in its original bottle, or it cannot be given to my pet.(Required) I have read and understandI agree that my pet is not aggressive and does not have a history of biting humans or fighting with other animals.(Required) I have read and agreeIs there anything you would like our team to check while your pet is boarding? (Any requests will be addressed at the doctor's discretion. Exam fees may apply.)Regular Veterinarian or Hospital Additional Services: One extra walk (there are a minimum of three walks per day) For Cats - 15 minutes of one-on-one playtime out of the cage with kennel personnel Bath (Baths will be performed on either the day before or day of pick up, based on availability. If your pet requires a medicated bath, medication must be provided by the owner.) Nail trim (we will perform this service if the pet allows and is not stressed by this process) All additional services have an additional fee associated with them.If you have selected a bath, please choose one of the following options(Required) I will pick up my pet BEFORE 2PM and understand that the bath would be done the night before I will pick up my pet AFTER 2PM and understand that the bath will be done the morning before departure Additional Pet Information My pet can have blankets during their stay My pet can jump over 6 feet My pet can be boarded with another pet (provide additional pet information below) I as the owner understand that if my pet destroys blankets/towels or bedding, the staff will not continue to offer them to my pet for the remainder of their stay and I will not hold Perinton Veterinary Hospital liable for ingestion of any materials.(Required) I have read and understandPlease provide the name of additional pet(Required) By selecting this option, Perinton Veterinary Hospital will not be held liable for any related injury or death.(Required) I have read and understandI understand that this does not guarantee my reservation. Reservations are not final until our office has confirmed.(Required) I have read and understandIf your pet becomes ill, we will make every attempt to contact you and/or your emergency contact at the numbers provided. If the situation is life-threatening and time does not allow prior notification, we will treat it accordingly. If the situation appears serious enough, your pet will be taken to Veterinary Specialists & Emergency Services at 825 White Spruce Blvd, Rochester for 24-hour care. If there are limitations to the care you wish us to provide for your pet, please communicate that to us before you leave your pet with us. By signing below you are indicating that: you understand that you are responsible for all charges relating to services you request and any treatments provided should your pet become ill and you will not hold the hospital or its employees responsible if anything should happen while your pet is outside the building.Signature(Required)CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.