Boarding Release Form"*" indicates required fields Boarding Rate is Subject to Change Without Notice-Current $30-40/night+tax Client Name First Last Check-In Date MM slash DD slash YYYY Check-Out Date MM slash DD slash YYYY Patient NameSpecies Canine FelineBreedAgeYearsMonth Canine Boarding $30/night + tax – Special Handling Fees May Apply ($8/day)Feline Condo Boarding $22/night + taxFeline Luxury Boarding $30/night + tax (NEED to request in advance) Do you want a bath at the end of stay? Yes No($30-50 + tax Additional Fee) If Yes, Pick-up AFTER 3pm unless CalledVaccinations Needed Influenza 1st $30 Influenza 2nd $30 (DO as soon as gets here!) Influenza yearly $30 Yearly $180EMERGENCY CONTACT INFORMATIONOwner Name First Last PhonePhoneLocal Agent First Last PhonePhoneFeeding InstructionsFeeding Instructions Main Street Vet provides Purina EN dry food for Dogs/ SD maintenance dry food for Cats. Owner ProvidedName*(Label Owner's food)# of Meals/day* One Two ThreeAmount fed per meal: (cans/cups)*Additional instructionsMedication Admin. ($5/day additional fee)Drug NameHow much?How Often? Add RemoveUSE STICKERS ON DAILY FORMSCurrent Known Medical ProblemsPick-up TimesBoarders are released ONLY during our normal office hours. We will NOT release a pet before or after our normal office hours or on days when we are closed (i.e. Saturdays, Sundays & Holidays). If you have requested to have your pet bathed at the end of their stay, please pick your pet up after 3pm to allow for adequate drying time.PLEASE INITIAL HERE INDICATING THAT YOU UNDERSTAND OUR PICKUP TIMESVaccination/ Parasite Control RequirementFor your pet's protection, proof of current vaccination is required at the time you drop-off your pet. It is the policy of the Main Street Veterinary Clinic that all dogs boarding ($30/night) with us are current on their rabies ($25), distemper-parvo ($25), influenza ($30) & bordetella ($20) vaccinations and that all cats be current on their fvrcp ($20) & rabies ($20) vaccination. If this information is not provided at the time you drop-off your pet, your pet will be vaccinated immediately following a complete physical examination by one of our veterinarians at an additional cost to you. In order to maintain a flea-free environment for all of our guests, all pets that arrive for boarding are inspected for evidence of flea infestation. If your pet is found to have fleas, it will be treated at your expense. If you recently applied prescription flea control to your pet, please indicate below:Name of product appliedDate of application MM slash DD slash YYYY ( Please note: if we notice pet has live fleas, additional flea control will be administered at your expense ($30), regardless of when recent product was applied)PLEASE INITIAL HERE INDICATING THAT YOU UNDERSTAND OUR VACCINATION REQUIREMENT AND FLEA TREATMENT POLICYBoarder BelongingsPlease describe & put labels on themItems Leash Collar Carrier Bedding Toys OtherBeddingsToysOtherBoarder BelongingsBoarding guests are welcome to bring toys, food and medication. WE provide clean blankets, bedding and bowls. We ask that you take your leashes and/or collars at time of drop off so they are not lost or misplaced. If boarding your feline, PLEASE label your carrier before you drop off to make easier at discharge. Although we make every effort to care for these items, Main Street Veterinary Clinic WILL NOT be held responsible for belongings that are lost or damaged. PLEASE INITIAL HERE THAT YOU UNDERSTAND OUR BELONGINGS REQUIREMENTBath(Prices vary up to $50-add’l charges may apply)If you wish to have your pet bathed at the end of their stay, additional charges will apply. To ensure your pet is dry at the time of pick-up we will ask that you pick your pet up after 3 pm.PLEASE INITIAL THAT YOU UNDERSTAND THE PICKUP TIMESBrush Out Additional $25 for long hair dogs/cats( Initial Here )Additional Services RequestPlease note if you would like any additional services for your pet while staying with us that these services are provided at additional cost (some are + tax). Nail Trim $15 Microchip ID $60 Bath $50 Examination $80 Anal Glands $15 OtherOtherBOARDING AUTHORIZATIONI am the owner/agent for the pet mentioned above, and I have the authority to execute this consent. I authorize the veterinary staff at Main Street Veterinary Clinic to treat my pet if it should become ill while boarding until I can be reached and to do whatever is necessary should an emergency situation arise. I understand that medical supervision is available during normal office hours. I authorize outdoor leashed walks for my pet and exercise in a fenced yard. I understand that any examination, bath, vaccines, special handling charges, etc are at additional cost to me and are subject to change without prior notice. I have read and understood the policies stated above and understand that payment is due at the time of pick-up.SignatureDate MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.