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Owner's Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

First Pet's Name

Sex

Female

Male

Spayed/Neutered/Intact

Spayed

Neutered

Intact

Pet's DOB or Approximate Age

Dog or Cat

Dog

Cat

Breed

Color

Second Pet's Name

Sex

Female

Male

Spayed/Neutered/Intact

Spayed

Neutered

Intact

Pet's DOB or Approximate Age

Dog or Cat

Dog

Cat

Breed

Color

Third Pet's Name

Sex

Female

Male

Spayed/Neutered/Intact

Spayed

Neutered

Intact

Pet's DOB or Approximate Age

Dog or Cat

Dog

Cat

Breed

Color

Requested Date of Drop off:(Required)

Date of Pick up:(Required)

Owner(Required)

Cell Phone Number(Required)

Pet's Name(s)(Required)

Email(Required)

Do you want your pets boarded in the same run (If you have more then 1 pet)?(Required)

Yes

Can your pet's eat together?(Required)

Yes

Splash/Swim Session ($12/session)(Required)

Yes

Would you like your pet scheduled for a Suite?(Required)

Yes

Person(s) to contact in case of emergency and Phone number(Required)

Playtime ($8/session)(Required)

Once a day

Twice a day

Every other day

None

(Choose one)

Can your pets play together?

Yes

N/A

Has your pet had their flea/tick preventative this month? (Date and name of product)(Required)

Would you like us to apply a flea/tick preventative?(Required)

Yes

Fecal? ($35)(Required)

Yes

Bath ($31) - Dependent on Availability -PICK UP AFTER 2PM (This does not include brush out but if you would like one then select groom) EXCLUDES CATS(Required)

Yes

Nail Trim ($9)(Required)

Yes

Groom- Dependent on Availability - PICK UP LATE AFTERNOON (starts at $55, By Appointment Only)(Required)

Yes

Is your pet spayed or neutered?(Required)

Yes

If not spayed, when was last heat cycle?

Special instructions - Include feeding instructions, medications, and anything you would like the doctor to check. Please DO NOT put any of your pet's medications in with their food. Medications need to come in original bottles. ($4/day medication fee)(Required)

Please List Belongings You Have Brought (Beds, Blankets, Toys, Etc.) PLEASE DESCRIBE:(Required)

Has your pet showed any symptoms of coughing or sneezing in the past 7 days?(Required)

Yes

We have been seeing many cases of Upper Respiratory Infections in this area. This can be spread from a healthy dog not showing any symptoms. Unfortunately if your dog does start coughing, you are responsible for the cost of the medications. Please be aware of cough like symptoms or sneezing and let us know if this develops with your pet.

PLEASE READ CAREFULLY:

For maximum protection we recommend that vaccinations be administered at least 5 days prior to boarding, if unable to provide proof of vaccination with a vaccine certificate or if vaccines are not up-to-date we will update the pet(s) vaccines at the owner's expense. Additionally if any fleas/ticks are observed on the pets(s) while boarding they will be given an application of a flea/tick preventative at the owner's expense.

We will not be responsible for any lost or damaged belongings. Please do not leave any toys or beds that you do not want to get damaged. We will do our best to prevent this, but dogs may act differently here then they do at home and may urinate/defecate on their beds or chew their toys. If your pet's bed is unable to fit into your washer at home then please do not bring it because we will not be able to wash the bed.

BEDDING: PLEASE READ AND SIGN

For the comfort of your pet, bedding can be used for your pet's boarding stay. Please understand that pets sometimes behave differently while boarding than at home. If you have provided bedding or would like the boarding team to use their bedding, you assume all risks. This includes any lost, ripped, or chewed bedding. By signing below you also acknowledge that if your pet were to chew and ingest some or part of bedding causing your pet to become sick, or require a life threatening intestinal surgery to remove the bedding, you assume all risks and financial responsibility as well.

Will your pet chew bedding?(Required)

Yes

Owner's Signature

Medical Illness Policy:

One of the advantages of boarding your pet(s) at a veterinary hospital is that veterinary attention is readily available should the need arise. If your pet( s) become ill, we will attempt to contact you or your emergency contact at the number listed above regarding your pet's symptoms, treatment options, and estimate of additional costs. However, if your pet develops common symptoms of diarrhea or vomiting due to stress or change of diet while boarding we will treat the animal. Most treatments for these symptoms are inexpensive, but if there are other treatments that are necessary we will attempt to contact you first. Please indicate your wishes below should your pet(s) require treatment to relieve immediate discomfort or to resolve an important medical conditions.

Select One(Required)

Please perform whatever service the doctor deems necessary for the best care of my pet until someone can be reached. This includes only non-elective and necessary diagnostics.

I authorize up to $ __ in medical care for my pet until someone can be reached.

Do not administer any medical treatment until specific authorization is given.

Dollar amount(Required)

Any medical treatment that is needed for injuries that occur as a result of more than one pet in a run or injuries to themselves due to separation anxiety will be at the expense of the pet's owner. Please be aware that animals kenneled can become scared and can hurt themselves or other pets as a result. For example some pets can become food aggressive with other animals, if you are aware of this please inform our kennel staff, so we do not feed your dogs together. We do our best to prevent this, but if injury occurs the pet owner is responsible for the costs. We will treat injuries as needed regardless of what is checked above.

There is no charge for pets picked up before 11 AM on the day of departure. There will be a full days boarding charge for any pets picked up anytime after 11 AM. On Sundays there will be no early check out available. You may pick up your pet between 4 - 8 PM Sunday evening. Please be aware that you will be charged for Sunday whether your pet is picked up Sunday evening or Monday morning. If your pet is receiving a bath while boarding it will be given on the day of departure, please pick up your pet after 2 PM Mon-Sat, if receiving a bath. You will not be charged a board fee for that day EXCEPT FOR SUNDAYS.

Suite prices will no longer include a BATH. You will not be charged for the day of pick up if you elect to get a bath for $31.

MON: 8 AM - 8 PM TUES: 8 AM - 8 PM WED: 8 AM - 8 PM THURS: 8 AM - 8 PM FRI: 8 AM - 8 PM SAT: 8 AM - 4 PM SUN: 4 PM - 8 PM Please note our boarding front desk hours.

I Have Read and Understand The Available Hours For The Pet Resort Front Desk's Drop Off And Pick Up Times(Required)

I agree to the statement above

Fees

Pricing for Felines:

For one cat: $21/day
2ND cat SHARING THE SAME condo is an additional $21/day
2nd cat in SEPARATE condo is $22/day
Pricing for Canine Kennels:
For one dog: $29/day
2ND dog SHARING THE SAME kennel is an additional $26/day
2nd dog in SEPARATE kennel is $27/day
Pricing for Canine Suites:
$45/day per dog
*There is a charge if you bring your own food and it is NOT prepackaged- $2/day per animal Medication fee is $4/day per animal and includes any prescription medication, over the counter medicine, supplement, vitamin, powder, etc.

Financial Arrangements:

I certify that I am the legal owner of the pet(s) being boarded. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release. I understand that payment can be made in the form of cash, check, MC, Visa, or Discover. I fully intend to pick up my pet(s) on the above-specified date. If circumstances change, I will notify Middletown Veterinary Hospital of a new pick up date and will pay in full the charges that were incurred at that time. I understand that if no notification of a delay is given, my pet will be considered abandoned after 3 days and will become property of Middletown Veterinary Hospital. I understand that my pet will be cared for in a conscientious and loving manner and be housed in a sanitary and properly enclosed facility. Therefore, I will not hold Middletown Veterinary Hospital responsible if my pet is lost, stolen, becomes ill or dies in their custody.

My signature certifies that I have read, understood, and agree to all the provisions herein concerning my pet being cared for at Middletown Veterinary Hospital.

Do you give permission for Middletown Vet to photograph your pet and possibly use it on our social media or website?(Required)

Yes

I understand boarding drop off and pick up resort front desk hours are: 8 am - 8 pm Monday - Friday; Saturday 8 am - 4 pm; Sunday 4 pm - 8 pm(Required)

Yes

I understand this reservation is not complete until I receive my confirmation email from Middletown Pet Resort & Spa. (If you do not receive a confirmation within 24 hours, please email resort@bestvetyet.com or call the resort directly at 302-378-2342.)(Required)

Yes

My name below certifies I have read and agree to the terms in this form(Required)

Date Signed(Required)

MM slash DD slash YYYY

Number