Animal Care Center Pet Lodging Agreement You must fill in a separate form for each pet!!!

Pet Name Client Name Pet Size - Select One - Dog - Under 25 lb. Dog - 25 to 50 lb. Dog - 50 lb. & above Cat Bird Reptile Small Mammal Boarding From - Select a Month - January February March April May June July August September October November December - Select a Day - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 To - Select a Month - January February March April May June July August September October November December - Select a Day - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

**All fields with red text are REQUIRED.

Vaccinations All vaccines must be current within the last year.   If you need assistance in determining whether or not your pet is current, please contact your veterinarian or our office. The staff of Animal Care Center can assist you in obtaining records of your pet's vaccination.  If you would like us to assist, please provide us with the following information. Veterinarian: Office Name: City: Office Number: It is the policy of some veterinary offices to not release health records of their patients to insure the privacy of their clients.  The Animal Care Center may not be able to obtain records for you.  If that is the case, most offices will fax records at the request of their clients.

Emergency Contact: (Name & Phone Number)

Diet Instructions Will you be bringing your own food for your pet?  If so, please leave feeding instructions below. No Yes Please specify feeding instructions:

Medication Is your pet currently on medication that will need to be administered while boarding?   If so, please leave medication, amount and dosing instructions below. No Yes Please specify medication name, amount, times given, route given, and any other information:

Grooming Pets boarding with us can be conveniently groomed prior to pick-up. Do you want this service? Yes No Would you like to schedule clipping while your pet lodges with us? Yes No

Exercise Do you want VIP care for your pet during boarding? Yes - once daily Yes - twice daily No VIP care Please specify desired activities:

Please take the time to fill out the personal information in order for our staff to process your request. E-mail address: Phone number:* * We need your phone number so we can contact you to confirm this reservation. If you would like to speed up the check-in process, we can fax the agreement form to you once it is determined by our staff that we will have space for your pet for the time indicated. Fax number:

Thank you for taking the time to fill out our online reservation form.  The staff of Animal Care Center will contact you as soon as your form is processed.