Boarding Registration Form
Flushing Animal Hospital
Today’s Date: __________________ Client Name: _____________________________________
Pet’s Name: _______________________________ (Please fill out a separate form for each pet.)
My pet has these known allergies/medical problems: _____________________________
Items Staying with My Pet (be as detailed as possible, i.e. color of blanket, type of toy):
Verified by animal care staff: ____________(Initials)
Feeding and Treat Instructions:
 Science Diet Original Adult/Growth (dry) is provided; will your pet be eating this?
 Are you bringing your own food?
YES NO
 When would you like your pet fed? AM only
YES
NO
If yes, what kind? _______________________
PM only
AM and PM
Leave Available
 How much food does your pet eat at each feeding (please be specific, i.e. 1 cup, ¼ can): ________
 Are you bringing treats?
YES
NO
If yes, when would you like them given? _____________
Medication Instructions:
 Will your pet be taking any medications while staying with us? (appropriate fees applied)
YES
NO
If your pet will be on medications, please list them and write the administration directions on the
back of this sheet.
Additional Services:
I would like my pet to receive the following while boarding (please circle to select, appropriate fees
applied):
 TLC (Tender Loving Care Session). Your pet may receive up to 3 TLCs daily in addition to their
regular walks.
YES NO
If yes, how many per day? ________
 Nail Trim
 Micro-Chipping
 Anal Gland Expression
 Feline Intestinal Parasite Fecal Test
 Feline Leukemia Vaccine
 Canine Influenza Vaccine
 DNA Test
 Canine Heartworm Test
 Canine Lyme’s Vaccine
 Feline Leukemia/AIDS Combination Test
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 I would like my pet treated with preventative parasite medication (appropriate fees applied, proof of current
heartworm test or prescription required for Advantage Multi, Sentinel, Triheart, and Comfortis ):
YES
Triheart
NO
Sentinel
If yes, please circle your preference:
Advantage Multi
Advantage
Advantix
Comfortis
 I would like my pet examined while here for boarding (appropriate fees applied):
Frontline
NO
YES
If yes, what signs or symptoms is your pet having? ________________________________________
Requirements:
All pets left for boarding must be current on all required vaccines and fecal testing. Proof of
vaccines and testing must be provided at check-in. If any vaccine or test is due within the same
month as the reservation, we require that it be updated prior to or during the reservation. All
vaccines must be given by a veterinarian and any procedure that cannot be verified at the time of
admission will be given at the owner’s expense. Required procedures are as follows:
DOGS:
CATS:
 A current bordatella vaccine
 A current rabies vaccine
 A current distemper combination vaccine given within the last 12 months, which must
include: distemper, hepatitis, parvovirus, adenovirus, Leptospirosis, coronavirus, and
parainfluenza.
 A negative intestinal parasite fecal test in the last 6 months
 A current rabies vaccine
 A current distemper combination vaccines given within the last 12 months, which
must include: rhinotracheitis, calicivirus, panleukopenia, and chlamydia.
All pets must be free of internal and external parasites (fleas, ticks, ear mites, tapeworms, etc.). If
parasites are found, treatment will be administered at the owner’s expense. Pets with positive
intestinal parasite fecal tests or visible tapeworms will be treated while here at the owner’s
expense.
I agree to pay for any hospital property damaged by my pet. This includes blankets, rugs, resting
boards, cages, etc. We cannot be responsible for loss or damage to any items accompanying your
pet during their stay. We reserve the right to refuse any belongings that we consider to be unsafe
to your pet while staying with us. We reserve the right to refuse any pets that we consider to be
unhealthy or aggressive.
Emergency Information:
In the event of an emergency, you can contact myself or the authorized people listed below to
make medical decisions for my pet:
Owner’s Name:
1.
2.
Additional Authorized Contacts:
1.
2.
Owner’s Phone Number:
Authorized Contact’s Phone Number:
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Please list any other people authorized to pick up your pet: __________________________
In the case of an emergency and no one can be contacted, I understand that Flushing Animal
Hospital will provide the necessary treatment to stabilize my pet until someone can be reached,
and that I am responsible for charges incurred to treat my pet.
_________________________________________
Signature of Owner or Responsible Party
__________________
Date
Risks of Respiratory Infections
Canine Influenza Virus
Several new respiratory infections have recently started to show up across the state
and country. These new infections have not all been completely identified and thus,
there are no vaccines available for them. These infections often occur when large
numbers of dogs are found in the same buildings, kennels, grooming facilities, and
pet stores for example. One of the most serious infections identified, Canine Influenza
Virus, does have a vaccine available. We do carry this vaccine and strongly
recommend that any dogs having contact with other dogs receive this vaccine.
None of these infections have been found in our area so far, but they are in the
surrounding states. The risk of contracting these types of infections is higher when
your pet is exposed to other dogs. This is a risk associated with boarding your dog.
Just as the airline is not responsible for your medical care if you get a cold on an
airplane, Flushing Animal Hospital is not responsible for the cost of any care needed
should your pet contract an infection while boarding. While contracting an infection of
this type is unlikely because of our diligent cleaning and disinfections, we felt it
necessary to make you aware that it does happen. With no vaccines available for
many of these infections, there is nothing we can do to prevent them.
We urgently recommend that you have your dog vaccinated against Canine
Influenza Virus! This vaccine may be required in the future.
I understand the risks associated with boarding my dog and I understand that
Flushing Animal Hospital is NOT responsible for any costs of medical care should a
problem occur. I understand that I am solely responsible for any costs incurred for
medical care should a problem occur.
Signature of Owner or Responsible Party
Flushing Animal Hospital Boarding Registration Form
Date
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