Carbon Valley Animal Hospital

101 W.Grant Ave
Firestone, CO 80520

(303)833-2244

www.carbonvalleyanimalhospital.com

Boarding Check In Form

First Name: (required)

Last Name: (required)

Pet's Name: (required)

Arrival Date: (required)

Departure Date: (required)

Please list any additional veterinary services that you would like to have done:

Please list feeding instructions for your pet (ex. 1 cup twice daily). If you provided your pet's own food be sure to also include the brand.

Please list any medications and/or supplements that your pet is currently on. Be sure to include dosing instructions.

I hereby authorize Carbon Valley Animal Hospital and Boarding kennels to board my pet. I am the owner and representative of my pet and agree to the following while my pet is boarding at CVAH.
1.) In case of illness or injury, I give my consent to the Doctors and employees of CVAH to treat, prescribe for, or operate on my pet while being boarding.
I understand that for such treatments I will be charged normal and ordinary fees, which will be due and payable at the time of release or pickup of my pet.
In the rare and unfortunate event your pet dies in our care, the remains will be maintained for pick-up and/or further instructions. (required)
I Agree to the Above Statement
2.) While I expect all reasonable precautions to prevent illness, injury, or escape of my pet, CVAH, it's owners, operators, or employees will not be held liable or responsible in any manner.
Under any circumstances for the care, treatment or safe keeping of my pet, it is thoroughly understood that I assume all risks. (required)
I Agree to the Above Statement
3.) I understand that the normal release or pick up of boarding animals is during normal business hours: 8AM-5:30PM Mon-Fri, and 9AM-12NOON on Saturday. (required)
I Agree to the Above Statement
4.) I understand that if I provide pet food for my pet that I am to bring an airtight plastic box or container. Owner's name, Pet's name and feeding instructions MUST be on the container.
I understand that if my pet requires medication to be given while boarding I am to provide it in the original bottle it was prescribed in
I understand there are no additional charges for administering my pets food, however there may be an additional charge for any medications given. (required)
I Agree to the Above Statement
5.) Should it become necessary to bathe my pet, I authorize CVAH to bathe but not groom my pet and will pay a normal or ordinary fee for this service. (required)
I Agree to the Above Statement
6.) I will claim or pick up my pet by the pick up date I have stated, or I will, in advance, notify CVAH of my intention to board longer.
Should my pet remain unclaimed, I give my permission to CVAH to act as representation of myself, and to take whatever action necessary to resolve this situation, including euthanasia. I will be responsible for accrued charges. (required)
I Agree to the Above Statement
7.) I understand that ALL CHARGES ARE DUE AND PAYABLE IN FULL upon the release of my pet from CVAH boarding facility. (required)
I Agree to the Above Statement
8.) All boarding animals must be current on all vaccines, at least ONE week prior to the boarding drop off date
I have read the above and agree to these terms. (Please sign by typing your first and last name): (required)

Date (mm/dd/yyyy): (required)

Owner Contact Number: (required)

Emergency Phone Number: (required)

ALL BOARDING ANIMALS MUST BE CURRENT ON THEIR VACCINATIONS

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