Name*

First

Last

Email*

Address

Street Address

Address Line 2

City

State

ZIP Code

Home Phone*

Cell Phone*

Work Phone

Desired Check-In Date*

Desired Check-Out Date*

Pet Name*

Pet Gender*

Male
Female

Spayed/Neutered?*

Yes
No

Pet Breed*

Pet Color*

Pet Birthday or Approximate Age*

Is Your Pet on Medication?

Yes
No

Nail Trim

Yes
No

Groom

Yes
No

Person(s) to Contact In Case of Emergency

First

Last

Emergency Phone

We ask that you please bring in prepackaged food for your pet. Below, please include any special instructions you may have regarding their food or feeding in general.

Did We Eat This Morning?*

Yes
No

Did We Eat Dinner?*

Yes
No

MEDICAL ILLNESS POLICY – If your pet becomes ill, we will call the emergency number(s) listed above. If no one can be reached however, please indicate your wishes below should your pet require treatment.

I have read and understand.

Please perform whatever services the Doctor deems necessary until someone can be reached. I authorize medical care for my pet up to the amount indicated:

$100
$200
$500
Other

Other

Boarding Playtime Option

I approve playtime – $19 per 15 minute session
I decline playtime

Amount of playtime sessions (15 minute session, charges apply)?

I understand that Barrington Square Animal Hospital is not responsible for lost or damaged items that I choose to leave (i.e., toys, leashes, collars, etc.)*

I have read and understand.

I HAVE READ AND UNDERSTAND THIS AGREEMENT. I FULLY INTEND TO PICK UP MY PET(S) ON 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 AUTHORIZED AGENT) PICK UP MY PET(S). I UNDERSTAND THAT IF I DO NOT PICK MY PET UP ON THE DESIGNATED DATE, I WILL BE CHARGED ADDITIONAL NIGHTS FOR BOARDING.*

I have read and understand.

Today's Date*

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

I have read and understand.

IF ARRANGING FOR A FRIEND OR FAMILY MEMBER TO PICK UP YOUR PET, PLEASE PROVIDE US WITH THEIR NAME AND PHONE NUMBER. ID IS REQUIRED AT PICK UP.

Feline Boarding Form

Get in touch

(847) 843-2226

Business Hours

(847) 843-2226