BOARDING RELEASE FORM

In Case of illness or injury, I, the undersigned, do hereby give my consent for Dr. Barbara Wynne, or her agents to treat, prescribe for or operate on my pet(s) while they are being boarded at the facility, if I am unable to be contacted. They are to use all reasonable precautions against illness, injury or escape of my pet(s).

If I neglect to pick up my pet within 5 days of the pick up date, with no contact from me, the owner, Wynne Veterinary Clinic may assume the pet is unclaimed. Unclaimed pets will be considered abandoned and dealt with according to local and state regulations. It is understood that such action will not relieve me from paying all costs of services and boarding.

• Vaccinations must be current for boarding and will be administered to any board animal not current, at an additional charge.
• Bordatella is required every 6 months.
• If fleas are present they will be treated upon arrival at an additional charge.
• If the pet becomes soiled while here a bath will be given at an additional cost of up to $45.00.
• Boarded pets often develop diarrhea associated with stress. If this occurs your pet may be treated with a special diet, anti-diarrhea medication or antibiotics at an additional charge.
• Wynne Veterinary will not be liable for injuries incurred if you want your pets boarded together. Any injuries that result from this will be treated at the owner's expense.

Owner:_________________________________ Pet Name:_________________________
Emergency Phone:_____________________________
Drop Off Date:____________ Pick Up Date:_______________
Drop off and pick up times are during our regular business hours:
Monday-Friday 9am to 12pm and 1:30pm to 5:30pm
Picking up pets when the office is closed will result in additional charges.

If you wish to leave personal items for your pet (i.e. leashes, toys, blankets, etc) we will make every effort to return these items to you. Please be aware that we are not responsible for lost or damaged items.

Instructions for your pet while boarding with us:

Feeding Instructions:

Special Diet:________________________________________________________

Dry____ Canned ____ Mixture of both____

Once a Day____ Twice a Day ____ Free Choice ____

Medications:________________________________ Owner Provided: Yes_____ No______

Optional Services:

Exam______

Toenail Trim________

Bath_______

Microchipping_________

I have read and understand this consent form
I will be paying for this visit by Check_____ Cash_____ Credit Card_____

Signed:____________________________________________