Boarding Agreement
<first-name> <last-name> <number>
Emergency Contact #:____________________
*In Case of Emergency*
Agent Name*:__________________________
Agent’s Contact #:_______________________
<animal>
<species>
Check-in date:_______________
Check-out date:______________
Pick-up time:________________
*Please ensure that your designated agent is aware that you have given us his/her name, and is willing and able to make decisions
regarding the care and well-being of your pet.
Initial:_______ All pets admitted must be current on their physical examinations by a doctor as well
as current on all required vaccines. Dogs must be current on Rabies, Da2PPV, and
Bordetella vaccines. Cats must be current on Rabies and FVRCP vaccines. If found to be past due,
your pet will be examined and given the necessary vaccinations and/or test upon admission and
current charges will apply. They must be free of external and internal parasites. **If your pet is found
to have evidence of parasites, they will be treated accordingly at the owner’s expense.
Playtime:
All pets boarded at Midway receive play time with the Patient Care technicians multiple times a day on
an individual basis. We do not do group play to reduce the likelihood of injuries to the pets in our care. If you
have any special requests or concerns regarding your pet, please list them below:
__________________________________________________________________________________________
__________________________________________________________________________________________
Bath at discharge: __________(Initial if you would like us to perform this service)
Offers your pet a bath and blow-dry before going home. Unless otherwise instructed your pet will be bathed
with Aloe and Oatmeal shampoo. There is an additional charge for this option.
Dietary Needs:
Unless otherwise instructed, your pet will be fed Hill’s Science Diet. If your pet has dietary needs
please provide enough food to last the entire stay, or allow us to provide it at the current price. Please specify
any dietary instructions below:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Medications:
Please bring all medications in their original containers. There will be additional fees of $5.00/day to
administer medication. If medications are not provided or run out, we will provide the medications at the
current rates. (If you have any questions about what this means, please ask one of our technicians). Please list
all medications to be administered:
Medication name:
Frequency:
Instructions:
PLEASE READ THE FOLLOWING:
I, <first-name> <last-name>, the undersigned, hereby warrant that I am the owner or authorized agent for the
animal listed in this record and do consent and authorize Midway Animal Hospital to care for and treat (if
necessary) said animal. 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 that every reasonable effort will
be made to contact me as soon as possible if an emergency or unanticipated situation arises with my pet. If I
am unable to be reached, I authorize the veterinarians to proceed with treatment as deemed necessary for the
well-being of my pet. I understand I will be held 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 at Midway: I consent to and authorize Midway Animal Hospital 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. While I expect all procedures to
be performed to the best of the abilities of the staff and doctors, I acknowledge that no guarantee or warranty
regarding the outcome or results of any treatment has been given. I understand that if an unanticipated need
for additional services occurs (e.g. extractions of teeth, blood work, x-rays, etc.), a reasonable effort will be
made to contact me using the contact information provided above. I understand that if I cannot be contacted,
non-emergency procedures or services will not be performed, and this may mean that my pet may need to have
another procedure at a future date at my expense. I acknowledge that hair may be shaved or clipped as
necessary to facilitate treatment.
I expect that reasonable precautions will be used to ensure my pet’s safety and well-being while in
Midway Animal Hospital’s care, and I agree to pay in full for all services provided at the time of discharge.
Authorized Signature:__________________________ Date:_____________