Boarding Agreement Boarding Agreement Drop-Off Date * Drop-Off Time 121234567891011 : 0030 AMPM Pick-Up Date * REMINDER – all pets must be picked up during regular business hours unless authorized Pick-Up Time 121234567891011 : 0030 AMPM Owner's Name * First Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Home Phone * Cell Phone * Work Phone * Email * Contact Person in case of Emergency * Phone * Pet(s) Boarding Canine/Feline * Canine/Feline Canine/Feline Are you providing your own food? * Yes No Type of Food & Instructions * Ex: wet or dry food; how much at each feeding and how many times per day Does your pet have any medical conditions that our staff should be aware of? * Yes No If yes, please explain Is your pet(s) currently taking medication(s)? * Yes No If so, list pet name, medication(s) and dosage(s) and when last given: *Please note: There will be an additional charge of $2.95/day for pets requiring medication during their stay at HVS. List any personal items brought with your pet: * For Your Pet's Health In an effort to reduce the spread of infectious and zoonotic diseases, HVS does require all pets to be current on vaccinations and the appropriate documentation provided. Thank you for your support and understanding. Dog: Rabies, DHPP (Distemper/Parvo), Bordatella (Kennel Cough) Cat: Rabies, FVRCP, FelV(Optional) If my pet is not current on vaccinations or I am unable to provide proof of such, I give my permission for HVS to vaccinate in accordance with the above policy. * If my pet is found to have fleas/ticks, I give my permission for HVS to administer medication. * **Additional fees do apply** The below selected services are requested, as time permits, during their boarding stay. Additional fees do apply. Microchip Toe Nail Trim Bath Anal Gland Expression Allergy Injection Recheck exam Examination OtherOther All reasonable precautions will be used to protect your pet(s) against illness, injury, escape or death during their stay at HVS. In the unlikely event of any of the above circumstances, HVS and staff will not be held liable provided that reasonable care and precautions were taken based upon company policy and AZ rules/statutes. I assume full responsibility for all expenses necessary to provide medical care as deemed appropriate by the on-staff veterinarian. Payment: I understand that I am financially responsible for payment in full for services rendered and that payment is due upon the release of my pet. Should default occur, HVS reserves the right to forward my bill to an attorney or collection agency and I will be held responsible for all expenses including, but not limited to, collection and/or attorney fees. Abandonment: If the pet is not called for within three days after the time specified for release and if the doctor or staff is not notified of an alternate date within the three-day period, the animal will be considered to be abandoned and may be turned over to the proper authorities as deemed necessary. It is understood that this does not relieve me from the accrued fees/debt in full. I have read and fully understand this Boarding Agreement Authorization. Signature of Owner or Responsible Party * signature keyboard Clear Today's Date * Submit If you are human, leave this field blank.
