Boarding Form

Best Phone Number To Reach You During Your Trip : *

Emergency Contact #1:

Name:
Phone #:

Emergency Contact #2:

Name:
Phone #:

Please list your pet(s) staying with us.

1. Pet Name:
2. Pet Name:
3. Pet Name:
4. Pet Name:

The undersigned hereby requests that their pet be allowed to board at Klondike Kennels. Prior to drop off the undersigned shall disclose to staff all information about their pet(s) health and temperament, including any incident of aggression. Any change in health or temperament or incident occurrence shall be disclosed in writing to Klondike Kennels prior to future visits.

It is understood and agreed that the undersigned's pet will be assessed by the staff for compatibility and compliance at every boarding visit, with Klondike Kennels reserving the right to terminate this agreement based on such assessment findings. Klondike Kennel reserves the right to request a trial day board at our discretion at any time during active or inactive periods of boarding in determining continued compatibility with boarding and owner agrees to pay any fees incurred for such assessment.

Klondike Kennels reserves the right to deny the undersigned for any reason, and to terminate this agreement of the undersigned and/or pet(s) from the facility for any reason. In the event this agreement is terminated no refunds will be made. Do you agree?*

yes

no

The undersigned understands that attendance in a boarding stay means that the undersigned is taking certain risks of damage or injury or exposure to health risks, including infectious disease to the undersigned's pet. The undersigned realizes that when pets are together in a confined area, some accident injury or sickness may result and that pets and property might be injured or damaged.

Because the undersigned wants to board his/her/their pet, the undersigned hereby agrees to assume any and all risks, whether known or unknown and assumes full responsibility for any injury or illness to the undersigned's pet.

In exchange for the opportunity to board, the undersigned hereby releases and discharges Blair Animal Clinic, P.C., Klondike Kennels, Inc. and their officers and employees, directors, property landlord or appointees or representatives from any and all liability, claimed, demands, causes of action, loss, damage, injury or illness to the undersigned's pet, including any death and/or serious injury which may result while the undersigned's pet are on the Klondike Kennels premises. The undersigned sears or affirms that they are 18 years old or older and have the legal capacity to enter into a binding contract. The undersigned intends for this release to be binding upon his/her/their heirs, beneficiaries, next of kin, personal representative or executor, and assignees. Do you agree*

yes

no

Due to the increased availability of boarding, daycare and dog park facilities in our community and other pet events where dogs can have direct contact with one another there is increased risk of exposure to illness, including canine infectious respiratory disease complex. These viruses (similar to a cold in humans) are something we cannot vaccinate for. We want to make all of our patrons aware that risk of exposure is increased when ogs participate in any activities where groups of dogs have contact with one another. In an effort to stave off the spread of respiratory illness to other facilities we ask that you list other facilities your dog frequents in the event we need to reach out to them as a way to prevent the spread of respiratory illness between different facilities.

Please enter today's date and type your name. Your typed name will serve as your signature in acknowledgment of The Boarding Agreement, Release and Waiver of Liability and Assumption of Risk and Addendum *

Date:
Name:

This is an agreement between Klondike Kennels and the pet owner whose signature appears below (hereinafter called "Owner").

Owner agrees to pay the rate for pet care provided in effect o the date pet is checked into Klondike Kennels.

Owner further agrees to pay all costs and charges for special services requested, and all veterinary costs for the pet during the period said pet is in the care of Klondike Kennels.

By signing this agreement and leaving pet with Klondike Kennels, Owner certifies to the accuracy of all information given about said pet. Klondike Kennels reserves the right to deny admittance to Owner's pet for any reason at any time

Owner specifically represents that he, she or they is the sole owner of the pet, free and clear of all liens and encumbrances.

Owner specifically represents to Klondike Kennels that, to Owner's knowledge, the pet has not been exposed to any contagious diseases within a thirty-day period prior to check-in. During the period of this agreement, Owner also agrees to notify Klondike Kennels of any known exposure of pet to a communicable disease and hold pet out of attending Klondike Kennels until pet is symptom-free for a minimum of 10 days or with a written veterinary clearance. Owner further agrees to maintain currency of vaccinations as required by Klondike Kennels policy.

Owner further agrees to be financially responsible for any required treatment for fleas/ticks, if determined necessary by the pet care provider.

All charges incurred by Owner shall be payable upon pick-up of pet(s). The Owner hereby agrees that in the event the charges are not paid when due in accordance with this contract, Owner must remit full payment within ten days. If full payment is not made within ten days the account will be turned over to creditors for collection.

If pet becomes ill or injured, or if the state of the animal's health otherwise requires professional attention, Klondike Kennels, in its sole discretion, may engage the services of a veterinarian or administer medicine or give other requisite attention to the animal, and the expenses thereof shall be paid by the Owner.

This agreement shall stand and be kept on file by Klondike Kennels for the period of one year. At the end of that one year this agreement shall become void and a new agreement must be signed.

Please enter today's date and type your name. Your typed name will serve as your signature in acknowledgment of The Pet Care Agreement *

Date:
Name:

Please provide your Veterinarian's Information:

May we contact your veterinarian to acquire proof of vaccination for your pet?

yes

no

Pet 1:

Major Health Problem(s):
Allergies:
Medication(s):

Pet 2:

Major Health Problem(s):
Allergies:
Medication(s):

Pet 3:

Major Health Problem(s):
Allergies:
Medication(s):

Pet 4:

Major Health Problem(s):
Allergies:
Medication(s):

I give my consent for the doctors and staff at Blair Animal Clinic, and/or the Purdue Animal Emergency Service, to stabilize my animal (s) in the case an emergency. I understand that in the event of an emergency Klondike Kennel staff will attempt to contact me at the number(s) provided above. I am stating that I will pay all fees incurred for stabilization, knowing that the Doctors on duty and/or Klondike Kennel staff will, to the best of their ability, attempt to reach me at the above number(s) for any further treatments, or reach my own Veterinarian for further medical care.

Please enter today's date and type your name. Your typed name will serve as your signature providing consent.

Date:
Name:

If the emergency is critical enough to refer the pet to Purdue University for intensive care, I give my consent for Klondike Kennel staff or Blair Animal Clinic staff to transport my animal to Purdue University for further treatment. I am stating that I will pay all fees incurred for that treatment, knowing that the Blair Animal Clinic Doctors on duty and/or Klondike Kennel staff will, to the best of their ability, attempt to reach me at the above number(s). I understand that treatment for Bloat will have to be done at Purdue University and that the cost of treatment can reach the amount of three thousand dollars.

Please enter today's date and type your name. Your typed name will serve as your signature providing consent.

Date:
Name:

I decline any and all emergency medical treatment. In event of an emergency, please contact me first. I understand that my pet will not receive any medical treatment, resuscitation, or stabilization until I am able to be contact by Klondike Kennel or Blair Animal Clinic staff. I understand that signing below voids any signatures for either of the above statements.

Please enter today's date and type your name. Your typed name will serve as your signature.

Date:
Name:

Please fill out one Pet Care Record for each pet staying with us.
Please describe everything as specifically as possible. (ie: green and pink polka dot collar)

Pet 1 Name:
Pet 2 Name:
Pet 3 Name:
Pet 4 Name:

Please tell us more about your pets.

Pet 1 Color:
Pet 1 Breed:
Pet 1 Age:
Pet 1 Sex:
Pet 2 Color:
Pet 2 Breed:
Pet 2 Age:
Pet 2 Sex:
Pet 3 Color:
Pet 3 Breed:
Pet 3 Age:
Pet 3 Sex:
Pet 4 Color:
Pet 4 Breed:
Pet 4 Age:
Pet 4 Sex:

Pet Belongings:

Pet 1 Collar & Leash:
Pet 1 Bedding:
Pet 1 Toy(s):
Pet 1 Food & Treats:
Pet 2 Collar & Leash:
Pet 2 Bedding:
Pet 2 Toy(s):
Pet 2 Food & Treats:
Pet 3 Collar & Leash:
Pet 3 Bedding:
Pet 3 Toy(s):
Pet 3 Food & Treats:
Pet 4 Collar & Leash:
Pet 4 Bedding:
Pet 4 Toy(s):
Pet 4 Food & Treats:

Pet Feeding Instructions (amount):

Pet 1 AM:
Pet 1 NOON:
Pet 1 PM:
Pet 2 AM:
Pet 2 NOON:
Pet 2 PM:
Pet 3 AM:
Pet 3 NOON:
Pet 3 PM:

Pet Medications. Please list the Pet Name, Medication name, reason, dosage, and if they take in the am, noon and/or pm.

Pet Name, Medication name, reason, dosage, am/noon/pm:
Pet Name, Medication name, reason, dosage, am/noon/pm:
Pet Name, Medication name, reason, dosage, am/noon/pm:
Pet Name, Medication name, reason, dosage, am/noon/pm:
Pet Name, Medication name, reason, dosage, am/noon/pm:
Pet Name, Medication name, reason, dosage, am/noon/pm:
Pet Name, Medication name, reason, dosage, am/noon/pm:
Pet Name, Medication name, reason, dosage, am/noon/pm:
Pet Name, Medication name, reason, dosage, am/noon/pm:
Pet Name, Medication name, reason, dosage, am/noon/pm:

Pet 1, Would you like any additional services:

Vet Appointment

Kennel Bath w/Nail Trim

Nail Trim

Stay & Play

Daycare

Stress-less Stay Package

Pet 2, Would you like any of these additional services?

Vet Appointment

Kennel Bath w/Nail Trim

Nail Trim

Stay & Play

Daycare

Stress-less Stay Package

Pet 3, Would you like any of these additional services?

Vet Appointment

Kennel Bath w/Nail Trim

Nail Trim

Stay & Play

Daycare

Stress-less Stay Package

Pet 4, Would you like any of these additional services?

Vet Appointment

Kennel Bath w/Nail Trim

Nail Trim

Stay & Play

Daycare

Stress-less Stay Package

When would you like these services offered to your pet(s)?

Do NOT give:

Pet 1 Blankets

Pet 1 Toys

Pet 1 Food/Treats

Pet 2 Blankets

Pet 2 Toys

Pet 2 Food/Treats

Pet 3 Blankets

Pet 3 Toys

Pet 3 Food/Treats

Pet 4 Blankets

Pet 4 Toys

Pet 4 Food/Treats

Boarding Form

Best Phone Number To Reach You During Your Trip : *

Emergency Contact #1:

Emergency Contact #2:

Please list your pet(s) staying with us.

Boarding Agreement:

Release and Waiver of Liability and Assumption of Risk

Read carefully to ensure full understanding before accepting.

Addendum:

Pet Care Agreement

Please provide your Veterinarian's Information:

May we contact your veterinarian to acquire proof of vaccination for your pet?

Pet Health Information:

Pet 1:

Pet 2:

Pet 3:

Pet 4:

Emergency Medical Treatment Release

Pet Care Records

Please fill out one Pet Care Record for each pet staying with us.
Please describe everything as specifically as possible. (ie: green and pink polka dot collar)

Please tell us more about your pets.

Pet Belongings:

Pet Feeding Instructions (amount):

Pet Medications. Please list the Pet Name, Medication name, reason, dosage, and if they take in the am, noon and/or pm.

Pet 1, Would you like any additional services:

Pet 2, Would you like any of these additional services?

Pet 3, Would you like any of these additional services?

Pet 4, Would you like any of these additional services?

When would you like these services offered to your pet(s)?

Do NOT give:

If you checked NOT to give any of your pets Food/Treats please explain:

Boarding Form

Best Phone Number To Reach You During Your Trip : *

Emergency Contact #1:

Emergency Contact #2:

Please list your pet(s) staying with us.

Boarding Agreement:

Release and Waiver of Liability and Assumption of Risk Read carefully to ensure full understanding before accepting.

Addendum:

Pet Care Agreement

Please provide your Veterinarian's Information:

May we contact your veterinarian to acquire proof of vaccination for your pet?

Pet Health Information:

Pet 1:

Pet 2:

Pet 3:

Pet 4:

Emergency Medical Treatment Release

Pet Care Records

Please fill out one Pet Care Record for each pet staying with us. Please describe everything as specifically as possible. (ie: green and pink polka dot collar)

Please tell us more about your pets.

Pet Belongings:

Pet Feeding Instructions (amount):

Pet Medications. Please list the Pet Name, Medication name, reason, dosage, and if they take in the am, noon and/or pm.

Pet 1, Would you like any additional services:

Pet 2, Would you like any of these additional services?

Pet 3, Would you like any of these additional services?

Pet 4, Would you like any of these additional services?

When would you like these services offered to your pet(s)?

Do NOT give:

If you checked NOT to give any of your pets Food/Treats please explain:

Release and Waiver of Liability and Assumption of Risk

Read carefully to ensure full understanding before accepting.

Please fill out one Pet Care Record for each pet staying with us.
Please describe everything as specifically as possible. (ie: green and pink polka dot collar)