Boarding Check-In Form

Drop off Date:*

Pick Up Date:*

Last Name:*

Pet's Information:

About my pet:

Name:
Breed:
Color:
Sex:
Age:

Diet

Will you be bringing food or using our food? *Please note: Using our food incurs an additional charge.

I will provide food for my pet

Please provide food for my pet

Please indicate the brand & specific types of food, as well as how often all foods are given.

Main Diet:
Treats/Greens/Fresh Foods:

Feed my Pet:

	AM	PM
Once a day
Twice a day

Does your pet have any dietary restrictions/foods to NOT feed?

Yes

If Yes, please explain dietary restrictions:

Does you pet prefer:

Water Bowl

Water Bottle

Other

Can your pet have a blanket/towel in their cage? Toys?

Yes

Other

Boarding Pet’s Medication (additional fee):

Is your pet on medication?

Yes

Medications Listed:

Name of Medication:
Directions:
Name of Medication:
Directions:
Name of Medication:
Directions:
Name of Medication:
Directions:

Boarding Pet's Personal Belongings

Are you leaving your pet's carrier?

Yes

While we do our best to return items left with your pet at the time of discharge, occasionally items can be misplaced. Therefore, we cannot accept responsibility for leashes, toys, blankets, etc. that may be lost while your pet is boarding. If you would still like to leave any personal belongings, please provide us with ENTIRE list below.

Being away from home can be a very stressful experience for many animals, and we are constantly evaluating your pet’s wellbeing during their stay with us. Stress can manifest in different ways in pets including, but not limited to, not eating, not urinating, or loose stool. While we do not expect any issues, we always want to act as quickly as possible while also respecting your time away/busy schedule should anything arise during their stay.

Please take a moment to review the options below and select which one works best for you. We are happy to answer any questions you may have regarding these additional treatments/services.

I authorize Animal House of Chicago to perform whatever procedures are deemed medically necessary for my pet in the event an issue arises.

I do not authorize Animal House of Chicago to perform any additional procedures outside of what is outlined in the provided estimate. Should an issue arise, staff should attempt to contact me before any action is taken. I understand that this may cause a delay in treatment for my pet.

I authorize Animal House of Chicago to perform procedures that are deemed medically necessary and fit within the allotted budget in the event an issue arises (Insert $ budget in 'Other' field below).

Other

Emergencies can strike at any time, even while in the hospital. While we will do everything within the range of our abilities to prevent an emergency, sometimes emergencies occur despite our best preventative efforts.

In the unlikely event of an emergency requiring cardiopulmonary resuscitation (CPR) during your pet’s boarding or hospitalization, would you like us to. (choose one)

ATTEMPT to resuscitate my pet-I understand that the procedures and medications during this event can be unpredictable and costly, and that by checking this box I agree to be responsible for any and all charges incurred during the resuscitation attempt. I also understand that the Animal House of Chicago is not equipped with a defibrillator, nor is it staffed 24hrs a day.

DO NOT ATTEMPT to resuscitate my pet. We will continue to inform you of any emergencies or deteriorating conditions as they occur, but CCPR will not be attempted.

Please share any additional comments or requests (grooming, treatment, etc.). Please note that we will review all requests at check-in and confirm what we’re able to accommodate at that time.

Boarding Check-In Form

Drop off Date:*

Pick Up Date:*

Last Name:*

Pet's Information:

About my pet:

Diet

Will you be bringing food or using our food? *Please note: Using our food incurs an additional charge.

Please indicate the brand & specific types of food, as well as how often all foods are given.

Feed my Pet:

Does your pet have any dietary restrictions/foods to NOT feed?

If Yes, please explain dietary restrictions:

Does you pet prefer:

Can your pet have a blanket/towel in their cage? Toys?

Boarding Pet’s Medication (additional fee):

Is your pet on medication?

Medications Listed:

Boarding Pet's Personal Belongings

Are you leaving your pet's carrier?

Please take a moment to review the options below and select which one works best for you. We are happy to answer any questions you may have regarding these additional treatments/services.

Emergencies can strike at any time, even while in the hospital. While we will do everything within the range of our abilities to prevent an emergency, sometimes emergencies occur despite our best preventative efforts.

In the unlikely event of an emergency requiring cardiopulmonary resuscitation (CPR) during your pet’s boarding or hospitalization, would you like us to. (choose one)

Please share any additional comments or requests (grooming, treatment, etc.). Please note that we will review all requests at check-in and confirm what we’re able to accommodate at that time.

Agreement

Typed Signature of Owner/Agent:

Today's Date:

Primary Phone Number:

Primary Email:

Secondary Phone Number:

Secondary Email