Boarding Admission Form: Client: Name _____________________
Pet Lodge Rates
Cats per night
Cage $9.00 per cat
Condo: $15.00 additional cat:$7.50
Dogs per night
$15.00 per dog
Pets Name:________________
Avian/Exotic per night
$11.30 per avian/exotic
Packages:
Canine: Gold ($9 per day) Silver ($5 per day) Bronze($2.5 per day)
Feline: Gold ($3 per day) Silver ($2 per day) Bronze ($1 per day)
OWNER RELEASE
Should an emergency arise, I authorize the medical staff of the North Country Animal Health Center to perform any emergency
procedures that become necessary to maintain the health of my pet. I agree to pay, in full, ALL charges for necessary services
rendered for and to my pet. If my pet presents with any obvious signs of external or internal parasites (fleas, tapeworms, etc.) I
understand that they will be treated at my expense. I also understand that my pet may have barked at other animals and the
temperature, combined with humidity, may have been slightly different than at home. This may create problems such as sore
throats or diarrhea and medication may be necessary for proper treatment. Our kennel is not responsible for personal belongings
left with your pet.
<Date> SIGNATURE________________________________ Emergency Phone # ________________
<first-name> <last-name>
I do______ do not _______ wish to be contacted to be notified of minor treatments that may occur while my pet is here (ie:
treatment for diarrhea, intestinal parasites, etc.)
**Please be aware that there may be administering fees applied to your account if your pet requires medication for minor treatments.**
PM
C play
Notes/Special Instructions for day
date:________
date:________
Qty.____per day
Qty:____per day
Qty._____per day
9 12 8
($35)
($11.60)
($2 each time)
($1.50 each time)
($1.80 each administration)
Medications
(today/tonight) Yes No
Bronze
Belongings
Date Admitted: _______Date of Pickup: ________Weight upon arrival:_________
Pets Name:___________________Breed:______________Color: ___________
Age: ______ Gender________ Weight: ____________
Date AM
Silver
A D U S A D U S
Packages: Gold
Additional Services:
Bath includes ear cleaning and nail trim
Nail Trim
Teeth Brushing
Additional Walk
Administering Medications
Add. Treatments
Feeding
(Today/Tonight) Yes No
O Kennel Food
O Own Food
Online Form Instructions: Please fill out your pet’s name, Breed, Color, Age, Weight, Gender and on the bottom of the page
circle any services you would like to be completed while your pet is here with us. If you plan to have your pet on a specific
diet, please fill out the instructions under the feeding column and whether or not you are bringing their own food with them.
Also write a very short description of any belongings your pet may have with them for their boarding stay. Under
Medications, write out the instructions for any medications your animal will be on for their stay. Please note: We do not
accept beds or large blankets, and medications do incur a charge per administration.