Name First Last Pet's NameBreedAgeSex Male Female Spayed/Neutered Yes No Date of Drop-Off MM slash DD slash YYYY Date of Pick-Up MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneCell PhoneEmail* Emergency Contact Name First Last PhoneRelationship to OwnerDoes your Emergency Contact have authorization to make medical and financial decisions on your behalf if we are unable to reach you? Yes No Primary Veterinarian NamePhonePlease list all medications with their directions that have been prescribed by your primary veterinarian. We will administer them explicitly as directed while your pet is in our care.Is your pet up-to-date on all vaccines? Yes No By signing below, you are authorizing Pets R Us Commerce City Animal Hospital to treat your pet as needed while in our care. If necessary, Pets R Us Commerce City Animal Hospital will transfer your pet to an emergency 24-hour facility if the attending doctor feels it is in the best interest of the pet. You acknowledge that you will be financially responsible for any charges incurred in this transfer, or additional fees incurred with Pets R Us Commerce City Animal Hospital. If your pet happens to pass away while being boarded, you also understand that you will be contacted immediately on how you would like to proceed with cremation or burial.InitialsPlease supply a credit card number in case of an emergency Visa Mastercard Discover American Express NumberExpiration DateCodeZip CodePlease list any additional treatment you would like your pet to have while staying with us (ex: bath, nail trim, vaccinations, brushing, etc.)Please describe any belongings you wish to leave with your pet. Also know that Pets R Us Animal Hospital will take the best care of your belongings as possible, but cannot guarantee their safe return: Bed/Blanket Toys Collar/Leash Other Please be sure to indicate feeding schedule and quantity of food your pet will be given on a daily basisPets boarding with Pets R Us Animal Hospital are required to be vaccinated against Kennel Cough (Bordetella). Your pet should have this vaccine at least 1 month prior to boarding for maximum protection. If we are administering the vaccination at the time of kenneling, or it has been less than one month since your pet received the vaccine, your pet is not fully protected. This vaccine should be given once every 6 months for the best coverage. By signing this, you understand the protocols for Bordetella vaccination, and that if your pet has not been vaccinated at least one month in advance for Bordetella. You cannot not hold Pets R Us Animal Hospital liable if your pet contracts Kennel Cough.InitialsShould circumstances arise that your pet remains unclaimed after the date that you have selected as the pick-up date without notice of an extended stay, written notice will be sent to your address. If you do not respond after seven (7) days, your pet will be considered abandoned and will be the property of Pets R Us Animal Hospital to do with as we feel is in the best interest of the pet.InitialsWe enjoy having your pet here with us, and would love to share cute moments on our Facebook page. By signing this waiver, you are permitting Pets R Us Animal Hospital to post pictures of your pet on social media. We will exercise good judgment, and will only highlight happy and pleasant moments.InitialsI understand that Pets R Us Animal Hospital charges boarding by the day. I will be charged a full day the day of drop-off regardless of what time my pet was brought in. I understand that if my pet is picked up before noon on the pick-up date, there will be no charge for that day. If it is after noon (12:00 pm), I will be charged an additional full day of boarding. I assume financial responsibility for all services performed upon my pet. Payment is due in full at the time the services are rendered. Pets R Us Animal Hospital may also recover reasonable attorney fees and court costs incurred as a result of my failure to payName First Last Date MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
