Coastal Animal Medical Center, LLC

6010 111th Street East, Bradenton, FL 34211

(941) 747-7107

Boarding Release Form

2/7/2017

Client Name: / Pet Names:
Telephone:
Arrival Date: / Pick up Person:
Departure Date: / Departure
Time:

Give names of any medications, the dosage to be given and how to be administered:

Feeding Instructions:

Treat Instructions:

Special Instructions:

Medical Condition:

Food Allergies:

Belongings:

If your pet decides not to eat or develops diarrhea/vomiting during the stay, our doctors may recommend giving prescription canned food, frozen probiotics, powdered probiotic or medication. There will be a charge for these treatment items. Do we have your permission to administer these items if recommended by a doctor without contacting you for permission? ⃝YES ⃝NO

The boarding suites are furnished with raised beds with soft bedding. The replacement cost if your dog chews the blankets is $12. If you think your pet may chew these items, it is best to remove them from the suite. If your dog does chew and eat the bedding, CAMC is not responsible for any injury or illness that may occur. Please indicate if these items should remain or be removed during the visit. ⃝Remain ⃝Remove

Standard boarding includes the suite, 3 outside play times each day accompanied by one of our team members (dogs only), administering oral medicines up to twice daily. Any extra services will be charged as indicated.

Boarding Rates per nightFirst PetAdditional Pet Same Suite

Cat Condo⃝$19.00⃝$ 9.50

Small Suite⃝$37.00⃝$18.50

Meduim Suite⃝$47.00⃝$23.50

Large Suite⃝$57.00⃝$28.50

Medication charge per day⃝$ 3.00

(daily medication charge applies to more than twice daily and for any pet needing injections)

I authorize and agree to pay for the following extras while my pet is boarding:

Extra Potty Break (5 min) $4.00 each AM PM Twice daily

Hugs and Kisses Session (5 min) $4.00 each AM PM Twice daily

Frozen Probiotic Treat(s) $2.50 each YESNO

⃝Bathby weight $26.50 - $57.75 (Pets will be bathed the pm before or am of discharge)

⃝Ear Hair Removal & Cleaning $29.97

⃝Pedicure $14.00

⃝Anal Gland Expression $17.75

⃝ I would like my pet to be examined by a vet: ⃝$55 non PPC ⃝Free for PPC member.

Reason for veterinary visit: ______

My pet has experienced an allergic reaction to this medication: ______and/or vaccinations ______, or ⃝ has no adverse reactions to medications and vaccination.
My pet is current on flea prevention? ⃝yes ⃝ no

What brand of flea prevention was given? ______

My Pet's vaccinations ⃝are current ⃝are not current.

If not current, I would like my pet to receive the following preventive care items:

Dog Preventive CareCat Preventive Care

⃝Fecal Exam$29.25⃝Fecal Exam $29.25

⃝Heartworm Test$45.57⃝ Heartworm/Aids/Leukemia Test$61.47

⃝Distemper Vaccination$22.47⃝ Distemper Vaccination$21.97

⃝Leptospirosis Vaccination$22.47⃝ Feline Leukemia Vaccination$29.97

⃝Lyme Vaccination$41.37⃝ Rabies Vaccination$19.00

⃝ Rabies Vaccination$19.47⃝ Microchip $46.97

⃝Manatee County License $17.00

⃝Rattlesnake Vaccination$32.75

⃝Bordetella Injectible$19.47

⃝Microchip$46.97

REQUIREMENTS FOR BOARDING

All animals must be current on vaccinations: Distemper, rabies, bordetella (dogs); Distemper, rabies (cats)

All animals must have been treated with a flea medicine within the past month or they will be treated here at owner's expense.

We allow our clients to bring items such as toys and bedding from home. There is a risk your pet may chew or soil these items. CAMC is not responsible for these items or for any injury they may cause your pet

We take all boarding dogs outside for playtime in our fenced yard. When they play outdoors, there is always a risk of bug bites, bee stings, and other injuries. CAMC is not liable for any such injury.

CAMC has my permission to do whatever is necessary should a medical emergency arise, and I agree to pay for any necessary charges.

Checkout time is 11:00 am. Pets may be picked up during normal business hours, but if not picked up by checkout time, client will be charged for the checkout day.

I understand that CAMC is not staffed 24 hours a day.

Receptionist: ______
I have read the boarding requirements and understand the hospital'spolicies.

Signed : ______