Vet Clearance Form - English Farm Kennels

Vet Clearance Form
3333 Hwy. 7, Norwood, ON. K0L 2V0
Tel: 705-639-8964 Fax: 705-639-8917
This form must be completed in full before your pet’s stay as our guest. Please
complete the form and include copies of your current vaccination records.
Dog Owner’s Name:_______________________________________
Dog’s Name:____________________________________________
Breed:_____________ DOB (or approx. age):__________ M/F ___
Veterinarian:____________________ Phone:_________________
Address: _______________________ Fax:___________________
If you are able, please have your Vet read over the following letter and sign.
I would like my dog to be a guest at English Farm Boarding Kennels while I am away and to
participate in their canine activities while they are enjoying their holiday. Please provide
English Farm Boarding Kennels with the following information by faxing this form to them
at 705-639-8917, at your earliest convenience.
I understand and agree that if my dog becomes injured or ill, English Farm Boarding
Kennels shall have the right to call a Veterinarian designated by me, or to call a Veterinarian
chosen by the English Farm Boarding Kennel, or to administer medicine or give other
advisable attention, or to obtain information about the dog at any time, within the discretion
and judgment of the Kennel.
a) If my dog needs medical treatment, I agree to reimburse the
Veterinarian/English Farm Boarding Kennels for services rendered for the
1. For all costs he/she deems necessary to make my pet well OR
up to a maximum of $_________.
2. If my dog is suffering from a terminal illness or injury, English
Farm Boarding Kennels will attempt to contact me first;
however, if I cannot be reached and my dog is suffering I give
permission to the Veterinarian to euthanize them, trusting their
professional discretion.
Thank you.
Signature of pet owner
English Farm Boarding Kennels
Date Administered
Flea Prevention:________
Yes or No
Other medical information English Farm Boarding Kennels should know
about my dog:
Signature of Veterinarian
Customer Agreement Form
English Farm Boarding Kennels (herein after called “Kennel”) agrees to exercise due diligence in the care
of my dog/cat. In addition English Farm Boarding Kennels agrees to keep its premises clean and sanitary.
My dog/cat will be cared for by Kennel staff or English Family members only, without liability on the
Kennels part for loss or damage including but not limited to disease, theft, fire, death, escape from fenced
areas, injury or harm to persons, other dogs/cats or property by my dog/cat, due diligence and care having
been exercised by English Farm Boarding Kennels. The Kennel shall exercise reasonable care for the animal
while boarding, however, it is expressly agreed that the Kennel’s liability shall in no event exceed the lesser
of the current chattel value of a pet of the same species or the sum of $50.00 per animal boarded. I further
agree to be solely responsible for any and all acts, damage, or behavior of said pet while it is in the care of the
I agree to pay the boarding rate in effect on the date my dog/cat is checked out of the English Farm Boarding
Kennel, as well as for any additional services requested or rendered. These costs shall be payable upon the
pick-up of my pet. I agree that the pet shall not leave the Kennel until all charges are paid to the Kennel. I
agree that the Kennel shall have, and is hereby granted, a lien on the pet for any and all unpaid charges
resulting from boarding my pet at the Kennel, including abandonment of the animal. I agree that in event that
the boarding charges are not paid when in accordance with this contract, the Kennel may exercise its lien
rights upon ten days written notice by certified mail.
I understand and agree that, if I do not pick up my dog/cat from the Kennel at the agreed upon date & time,
and I have not contacted the Kennel to arrange an alternate time to pick up my dog/cat, The Kennel will
consider my dog/cat abandoned and will turn my dog/cat over the Peterborough Humane Society.
I understand and acknowledge that animals can be unpredictable in behavior and may cause damage to
property, people, or other animals for which the Kennel could be held liable. I agree that I am solely
responsible for any damage or harm to property, people, or other animals caused by my dog/cat while under
the care of the Kennel. I hereby agree to indemnify English Farm Boarding Kennel for any and all claims
resulting from the actions of my dog/cat. I understand that I am solely financially responsible, including
Veterinarian charges required, for any damage or harm caused by my dog/cat while under the care of English
Farm Boarding Kennels.
Should my dog/cat become ill or seem to be in need of medical attention, English Farm Boarding Kennels, in
its sole discretion, reserves the right to administer aid and/or to engage the services of any available
veterinarian. My dog’s/cat’s personal veterinarian will be contacted first, but if not available, the Kennel’s
vet will be contacted. I shall pay any expenses incurred as a result of this medical attention. The Kennel will
not be held responsible for any disease or illness contracted by the pet during its stay. I have completed a
Vet’s Clearance Form as requested.
Note: I have____ or have not____ left my credit card number and authorization
with my veterinarian to apply necessary fees incase of an emergency. (Please
initial where applicable)
My *dog/cat is in good general health and valid proof that he/she is current on Rabies, *BHLPP, *Bordatella
and *Parvovirus vaccinations will be provided before he/she can stay at the Kennel. In addition my dog is on
a scheduled flea/tick prevention program. Pets arriving with fleas and/or ticks will be bathed at owner’s
Should my dog/cat exhibit inappropriate aggressive behavior toward other animals or people, for the safety of
all concerned, he/she will be placed in a secure run/cage separate from other animals.
I understand and agree that, if English Farm Boarding Kennels deems within its discretion and judgment that
my dog/cat cannot safely adapt to the boarding care provided by the Kennel, that the Kennel shall have the
right to place my dog/cat in another kennel of its choice at my expense.
English Farm Boarding Kennels reserves the right to refuse any dog/cat.
I have read and understand and agree to the terms above. This contract will be kept on file and will be valid for
one year from the date below.
Signature of Owner
Printed name of Owner
Dog’s / Cat’s Name
English Farm Boarding Kennel Representative
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