"*" indicates required fields

Client Name*

First Last

Client Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Pet name*

Breed*

Age*

Weight*

Veterinarian*

Veterinarian Phone*

I, the undersigned client, hereby give my consent for my pet named above to be boarded at the Facility. I understand and acknowledge that the Facility is unstaffed between the hours specified in the notice and that my pet will be left unattended during those times during their boarding stay. By signing this consent form, I agree to release the Facility, its owners, employees and agents from any and all liabilities, claims or expenses that arise from my pet’s boarding stay, including but not limited to injuries, illnesses or death. I have read and understood the statements outlined in the notice and in this consent form and release. I voluntarily consent to my pet staying at the Facility and acknowledge that I am solely responsible for any consequences that might arise during their stay.*

I give consent

Signature*

Date*

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