Canine Boarding Release Form – Hawthorne Animal Hospital

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Canine Boarding Release Form

11966 Roe Ave, Overland Park, KS 66209
Hours of Operation: Mon, Wed, Thu, Fri: 7:30–5:30
Tues: 7:30–7:00 Sat: 8:00-12:00pm Sun: Closed
Ph: (913) 345-8147 Fax: (913) 345-0801

Name
First Last
Emergency Contact Name
First Last
Emergency Contact Number
Permission for another person to pick up
- Yes
- No
If yes, whom?
First Last
Patient/dog name(s)
Arrival day & date (drop off at least 2 hours prior to closing time)
Date Format: MM slash DD slash YYYY
Departure day & date
Date Format: MM slash DD slash YYYY
If known, will the pickup time be Morning or Afternoon?
- Morning
- Afternoon
What brand of food does your pet eat?
We Provide Science Diet and iVet foods. If your dog eats a different diet that you want fed while boarding, please bring it with you. We may add canned food if we feel it necessary for the health of your dog.
**Please let us know if your dog is on a restricted diet**
How much does your pet eat? (in cups/cans)
How often?
Are any Medications necessary while boarding? (additional medication administration fee will be charged)
- Yes
- No
Please list medications, dosages and the time they are given
I request my dogs be boarded together in the same kennel (upon hospital discretion)
- Yes
- No
Date of last flea product given and name of product used
Date Format: MM slash DD slash YYYY
For an Additional Fee:
Would you like your dog(s) to play in the Doggie Daycare? (Not available on Sundays)
- Yes
- No
“Group play” is offered Mon-Fri if your pet wants to meet friends. If your pet isn’t into social activities “Individual play” is available Mon-Sat. (Some dogs will go into individual play with their other family members OR if not playing well with others.)
Group play: Dog name(s)
Group play: # Days playing
Individual Play: Dog name(s)
Individual Play: # Days playing
Would you like your dog(s) bathed while boarding?
- Yes
- No
if yes, which dog?
Would you like your dog(s) groomed while boarding?
- Yes
- No
if yes, which dog?
*Please understand there is no guarantee of a bath or groom unless confirmed in person at check in.*
Grooming Instructions:
Requirements for Boarding
1. All dogs must be current on all vaccinations including Rabies, Distemper Combo, Bordetella & Bivalent Influenza and must have had a negative fecal test within the last year. (Proof of vaccinations must be shown at time of check in or before)
2. All dogs must be free of signs of external parasites (ex. Fleas, Ticks, etc.) or they will be treated at owner’s expense.
3. Hawthorne Animal Hospital has my permission to do whatever is necessary should an emergency arise with my pet, and I understand that I am financially responsible for this treatment.
4. If my dog experiences a mild gastrointestinal upset, needs anxiety medications and/or a tranquilizer is necessary for treatment or handling or for the well-being of the pet, Hawthorne Animal Hospital has my permission to administer medication for treatment without prior notification.
5. Pets must be picked up before 5:30 PM on Monday, Wednesday, Thursday & Friday, before 7:00 PM Tuesday and before Noon on Saturday. No Exceptions. Pets will be charged an additional night of boarding if not picked up prior to the closing time. No Sunday pickup.
I have read the boarding requirements and understand the hospital’s policies.*
I agree
Signature*
First Last
Date*
Date Format: MM slash DD slash YYYY

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Request an Appointment
913-345-8147
Our Staff
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Careers
Location
Online Forms
Testimonials
Pet Health Resources
Online Pharmacy

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