Name *

First

Last

Pet's Name *

Phone Number *

Please note our pick up times:
Monday-Friday: 7:00 am – 5:00 pm (closed from 12:00 pm to 1:30 pm for lunch)
(There will be a half-day charge for pick-ups after 12 pm)
Saturday: 8:00am – 12:00 pm
Sunday: No pickup or drop off

Check in Date *

Check out Date / Time *

Date

Time

Alternative emergency phone number in case I can’t be reached: *

In the event of an extreme weather event and/or power outage, please provide a name and contact information for someone that can retrieve your pet from boarding: *

Has your pet shown any recent signs of diarrhea, vomiting, sneezing, or coughing? *

Yes
No

If yes, please explain: *

Have there been any other unusual symptoms or signs that we should be aware of? *

Yes
No

If yes, please explain: *

A CAPSTAR WILL BE GIVEN TO ALL DOGS AND CATS UPON ARRIVAL AT THE CLINIC TO CONTINUE TO HAVE A FLEA FREE ENVIRONMENT UNLESS ON BRAVECTO, NEXGARD, SIMPARICA, TRIFEXIS, OR ADVANTAGE MULTI.

Are you already using a flea prevention? *

Yes
No

Capstar is $12.00

Please specify which flea prevention you are using *

Would you like your pet to receive a bath?

Yes
No

50% off bath after 3 nights or more.

I understand that Crossroads Animal Hospital requires all pets to be current on vaccinations and have had a negative fecal exam within the last six months in order to stay at the hospital. If my pet(s) are not current on vaccinations and I have not shown proof that a licensed veterinarian has vaccinated my pet, I give consent for my pet(s) to be vaccinated by Crossroads Animal Hospital. If parasites (ticks, fleas or intestinal worms are found on your pet while in our facility, they will be treated at your expense to prevent exposure to other pets. If your pet requires medication while boarding, please bring it to the attention of the receptionist upon check-in. I understand that I will be responsible for all charges when my pet(s) are picked up. *

I have read and understand.

Canine needs the following:

Feline needs the following:

Is your pet on any medications? *

Yes
No

Please note, there is an additional fee for medication administration.

if yes, please list all medications and dosing instructions

Have they had their medications today?

AM Dose
PM Dose

How many cups does your pet eat per day? *

Other services needed:

Items left with pet (please minimize belongings):

Do you give permission for any picture taken during your pet stay to be used on our social media/website? *

Yes
No

Our dogs like kennel treats so we offer frozen KONG Peanut Butter Treats during their stay *

Yes, my pet can have kennel treats.
No, my pet cannot have kennel treats.

Will you be boarding another pet?

Yes
No

Second Pet's Name *

Has your pet shown any recent signs of diarrhea, vomiting, sneezing, or coughing? *

Yes
No

If yes, please explain: *

Have there been any other unusual symptoms or signs that we should be aware of? *

Yes
No

If yes, please explain: *

A CAPSTAR WILL BE GIVEN TO ALL DOGS AND CATS UPON ARRIVAL AT THE CLINIC TO CONTINUE TO HAVE A FLEA FREE ENVIRONMENT UNLESS ON BRAVECTO, NEXGARD, OR SIMPARICA.

Would you like your pet to receive a bath?

Yes
No

50% off bath after 3 nights or more.

I understand that Crossroads Animal Hospital requires all pets to be current on vaccinations and have had a negative fecal exam within the last six months in order to stay at the hospital. If my pet(s) are not current on vaccinations and I have not shown proof that a licensed veterinarian has vaccinated my pet, I give consent for my pet(s) to be vaccinated by Crossroads Animal Hospital. If parasites (ticks, fleas or intestinal worms are found on your pet while in our facility, they will be treated at your expense to prevent exposure to other pets. If your pet requires medication while boarding, please bring it to the attention of the receptionist upon check-in. I understand that I will be responsible for all charges when my pet(s) are picked up. *

I have read and understand.

Canine needs the following:

Feline needs the following:

Is your pet on any medications? *

Yes
No

Please note, there is an additional fee for medication administration.

if yes, please list all medications and dosing instructions

Have they had their medications today?

AM Dose
PM Dose

How much/often does your pet(s) eat? *

Other services needed:

Items left with pet (please minimize belongings):

Do you give permission for any picture taken during your pet stay to be used on our social media/website? *

Yes
No

Our dogs like kennel treats so we offer frozen KONG Peanut Butter Treats during their stay *

Yes, my pet can have kennel treats.
No, my pet cannot have kennel treats.

Do you have a third pet?

Yes
No

Third Pet's Name *

Has your pet shown any recent signs of diarrhea, vomiting, sneezing, or coughing? *

Yes
No

If yes, please explain: *

Have there been any other unusual symptoms or signs that we should be aware of? *

Yes
No

If yes, please explain: *

A CAPSTAR WILL BE GIVEN TO ALL DOGS AND CATS UPON ARRIVAL AT THE CLINIC TO CONTINUE TO HAVE A FLEA FREE ENVIRONMENT UNLESS ON BRAVECTO, NEXGARD, OR SIMPARICA.

Would you like your pet to receive a bath?

Yes
No

50% off bath after 3 nights or more.

I understand that Crossroads Animal Hospital requires all pets to be current on vaccinations and have had a negative fecal exam within the last six months in order to stay at the hospital. If my pet(s) are not current on vaccinations and I have not shown proof that a licensed veterinarian has vaccinated my pet, I give consent for my pet(s) to be vaccinated by Crossroads Animal Hospital. If parasites (ticks, fleas or intestinal worms are found on your pet while in our facility, they will be treated at your expense to prevent exposure to other pets. If your pet requires medication while boarding, please bring it to the attention of the receptionist upon check-in. I understand that I will be responsible for all charges when my pet(s) are picked up. *

I have read and understand.

Canine needs the following:

Feline needs the following:

Is your pet on any medications? *

Yes
No

Please note, there is an additional fee for medication administration.

if yes, please list all medications and dosing instructions

Have they had their medications today?

AM Dose
PM Dose

How much/often does your pet(s) eat? *

Other services needed:

Items left with pet (please minimize belongings):

Do you give permission for any picture taken during your pet stay to be used on our social media/website? *

Yes
No

Our dogs like kennel treats so we offer frozen KONG Peanut Butter Treats during their stay *

Yes, my pet can have kennel treats.
No, my pet cannot have kennel treats.

Do you have a fourth pet?

Yes
No

Fourth Pet's Name *

Has your pet shown any recent signs of diarrhea, vomiting, sneezing, or coughing? *

Yes
No

If yes, please explain: *

Have there been any other unusual symptoms or signs that we should be aware of? *

Yes
No

If yes, please explain: *

A CAPSTAR WILL BE GIVEN TO ALL DOGS AND CATS UPON ARRIVAL AT THE CLINIC TO CONTINUE TO HAVE A FLEA FREE ENVIRONMENT UNLESS ON BRAVECTO, NEXGARD, OR SIMPARICA.

Would you like your pet to receive a bath?

Yes
No

50% off bath after 3 nights or more.

I understand that Crossroads Animal Hospital requires all pets to be current on vaccinations and have had a negative fecal exam within the last six months in order to stay at the hospital. If my pet(s) are not current on vaccinations and I have not shown proof that a licensed veterinarian has vaccinated my pet, I give consent for my pet(s) to be vaccinated by Crossroads Animal Hospital. If parasites (ticks, fleas or intestinal worms are found on your pet while in our facility, they will be treated at your expense to prevent exposure to other pets. If your pet requires medication while boarding, please bring it to the attention of the receptionist upon check-in. I understand that I will be responsible for all charges when my pet(s) are picked up. *

I have read and understand.

Canine needs the following:

Feline needs the following:

Is your pet on any medications? *

Yes
No

Please note, there is an additional fee for medication administration.

if yes, please list all medications and dosing instructions

Have they had their medications today?

AM Dose
PM Dose

How much/often does your pet(s) eat? *

Other services needed:

Items left with pet (please minimize belongings):

Do you give permission for any picture taken during your pet stay to be used on our social media/website? *

Yes
No

Our dogs like kennel treats so we offer frozen KONG Peanut Butter Treats during their stay *

Yes, my pet can have kennel treats.
No, my pet cannot have kennel treats.

In case of illness or injury, I, the undersigned, do hereby give my consent for the doctors of Crossroads Animal Hospital to treat, prescribe for, or operate on my pet(s) while they are being boarded here at this hospital. The staff at C.A.H. are to use all reasonable precautions against illness (diarrhea, vomiting, sneezing, coughing), injury, or escape of my pet(s) and will not be held liable or responsible in any matter whatsoever, under any circumstances, on account of the care, treatment, or safekeeping of my pet(s) during or after my pet(s) stay, as it is thoroughly understood that I assume all risks. *

I have read and understand.

I have read and understand this form and by my signature give Crossroads Animal Hospital permission to take care of my pet as so directed. I also understand that payment is due at time of service. *

I have read and understand.

Signature

Clear Signature

Boarding Release Form

Boarding Release Form

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