Owner's Name*

Spouse/Other*

Address

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

Email Address*

Alternative Contact

Phone*

Medications and Diet

All medications must be in their original containers. If medications are not provided, you will be charged at current rates. Please list all medications below including dosage and instructions.

Medication Name

Dosage Amount

Dosage Instructions

Unless instructed otherwise, your pet receive Hills Science Diet. If your pet has other dietary needs, please provide the food or allow us to provide it at current rates.

Please specify dietary instructions

Please list personal belongings accompanying your pet

Boarding Fees

Complete Care is provided for our healthy boarders for $27.50 per night and offers your pet special attention at meals, behavior and health observations by trained professionals, and human contact to make your pet feel at home.
Complete Care with Medical Supervision for $26.00 per night is provided for those pets that have extensive special needs and to pets that are diabetic and require insulin injections and/or special monitoring. Up to two insulin injections per day are included. They will receive close monitoring by our trained staff of medical professionals during the hospital's normal hours.

Acknowledgments

I acknowledge that all pets admitted must be current on their physical exam and all vaccinations and that if my pet is past due, the pet will be examined and given the necessary vaccinations, and current charges will apply.
I acknowledge that all pets admitted are free of parasites and if any of the pets have evidence of parasites, they will be treated at owner's expense.

The undersigned hereby warrants that they are the owner or authorized agent for the pet listed in this record and does consent and authorize Ruston Animal Clinic to care for and treat said pet.
If an emergency situation arises, I authorize services, including the use of anesthesia if necessary, to treat my pet until such time as I can be contacted. I understand I will be responsible for all charges incurred at checkout. If I have requested that medical, surgical, dental, or other services be performed for my pet while boarding, I consent to and authorize Ruston Animal Clinic to perform diagnostic, therapeutic, anesthetic, emergency, and surgical procedures as are necessary and advisable for the treatment and maintenance of my pet's health and well-being. I understand that with any procedure or treatment that there are risks that may not be predictable, including death, and I accept these risks. I agree to pay in full for all services provided at the time of discharge.
Any pet not claimed within ten (10) days of pick-up date, without new provisions being made, will be considered abandoned, becomes the property of Ruston Animal Clinic and will be handled according to our best judgement.

Signature

Print Name

Date

Boarding Agreement and Registration Form

Medications and Diet

Boarding Fees

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