First Name*

Last Name*

Phone #*

Pet Name*

Breed/Age*

Check-In Date*

Pick Up Date*

Emergency Contact (Name and Phone #)*

Pet Weight*

Feeding Instructions*

Who Provides the Food*

I’ll provide my own food
Please use clinic-provided food. I understand I will be charged $2.75 per meal

Medication Instructions ($6.50 per day/per pet):*

Medication Time of day to give?*

Medical Policy: If Intestinal parasites are found in a requested fecal exam or if any fleas and ticks are found on your pet, they will be treated and I will be charged. This is to protect your pet and our other patients. If your pet becomes ill, we will call the emergency number(s) listed above. In the event that your pet requires immediate treatment and no one can be contacted, please indicate your wishes below.

Please perform whatever services the doctor deems necessary until someone can be reached. I authorize medical care up to the amount indicated.

Please select a medical care authorized amount*

Please list other medical amount*

Overnight Boarding*

Additional Services Offered

Playtime with overnight boarding (not daycare)*

I approve playtime at a cost of $17 per 15 minute session.
I decline playtimes

Number of sessions requested:*

Bath / Nail Trim/Anal Gland Expression*

I am requesting my pet be bathed or have other services prior to pick up (Bathing service instructions will be taken at drop-off)
I decline bath, nail trim, anal gland expression at this time

Grooming*

I am requesting my pet be groomed prior to pick up (Grooming instructions will be taken at drop-off)
I decline grooming at this time

Photography

I grant Barrington Square Animal Hospital, its representatives, and employees permission to take photographs of my pet. I understand that the images may be used in print publications, online publications, presentations, websites, and social media.*

Accept
Decline

I have read and understand this agreement. I fully intend to pick upon the above-specified date. If circumstances change, I will notify Barrington Square Animal Hospital immediately. In addition, I understand that payment in full for all services provided will be due/payable at the time I (or the authorized agent) pick up my pet. I understand that if I do not pick up on the designated date, I will be charged additional nights for boarding.

Special Instructions

Please list any special instructions. Include name and phone number if someone other than you will be picking up your pet.*

Date*

Owner/Authorized Agent Signature*

Canine Boarding Form

Additional Services Offered

Photography

Special Instructions

Get in touch

(847) 843-2226

Business Hours

(847) 843-2226