WP E-Signature by Approve Me - Sign Documents Using WordPress -

BEAVER BROOK ANIMAL HOSPITAL

Boarding Admission/Release Form

Name of Pet:

Check in Date: Departure Date:

Weight: lbs

Emergency Contact Name:

Emergency Contact Number:

Please check:

*Is your pet currently on any medication(s) YesNo

Additional fees will apply

If yes, please list prescription name, amount given and time administered

* In the last month has your pet received:

Flea and Tick Prevention: YesNo

Type:

Heartworm Prevention: YesNo

Type:

**If your pet is not current with Flea and Tick Prevention or we find live fleas, it will be applied to them at the cost of up to $30.00**

*Please feed my pet: Hospital’s Sensitive Stomach ($3 per meal)My Supplied Food

Type:

Amount to be fed at each meal:
    AM:
    MID:
    PM:

If CAT- is your cat eligible to roam? This means we must be able to gather your cat and place them back into their enclosure without inducing fear/anxiety or any additional stress.

Yes

List personal items staying with your pet, items must be marked with pet’s name. (We can not guarantee the return of listed items.)

List any special instructions or care your pet will need while staying with us.

Please check any services you would like provided during your pets stay:

Suite Treat - $5.00 each, How Many?

Additional Pet Photo - $5.00 each, How Many?

Additional Walk - $5.00 per 10 mins, How Many?

Individual Cuddle Time, 15 mins. $15.00 How Many?

Individual Play Time, 15 mins. $15.00 How Many?

Individual Pool Time (weather appropriate), 15 mins. $15.00 How Many?

Go-Home Bath $40 depending on weight YesNo

Grooming/Bath with Groomer? YesNo

Full Groom Packages and spa services available, please speak with Groomer about scheduling and fees

As the owner or authorized guardian of this animal, I give permission to the Beaver Brook Animal Hospital to receive, treat, prescribe or otherwise care for the animal above as deemed necessary.

I understand that Beaver Brook Animal Hospital will exercise the option to proceed with treatment if no one is available for clearance. Max Amount $

April 27, 2024

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Timestamp

Audit

January 20, 2022 1:33 pm EDT

Boarding Admission Uploaded by Beaver Brook - bbah@beaverbrookah.com IP 98.175.158.97

January 20, 2022 2:31 pm EDT

Beaver Brook - bbah@beaverbrookah.com added by Beaver Brook - bbah@beaverbrookah.com as a CC'd Recipient Ip: 72.200.141.178

January 20, 2022 2:33 pm EDT

Beaver Brook - bbah@beaverbrookah.com added by Beaver Brook - bbah@beaverbrookah.com as a CC'd Recipient Ip: 72.200.141.178

July 27, 2022 2:15 pm EDT

Beaver Brook - bbah@beaverbrookah.com added by Beaver Brook - bbah@beaverbrookah.com as a CC'd Recipient Ip: 70.168.6.118

December 21, 2022 5:30 pm EDT

Beaver Brook - bbah@beaverbrookah.com added by Beaver Brook - bbah@beaverbrookah.com as a CC'd Recipient Ip: 70.168.6.118

August 29, 2023 2:59 pm EDT

Beaver Brook - bbah@beaverbrookah.com added by Beaver Brook - bbah@beaverbrookah.com as a CC'd Recipient Ip: 98.175.158.97

August 29, 2023 3:06 pm EDT

Beaver Brook - bbah@beaverbrookah.com added by Beaver Brook - bbah@beaverbrookah.com as a CC'd Recipient Ip: 98.175.158.97

March 5, 2024 4:17 pm EDT

Beaver Brook - bbah@beaverbrookah.com added by Beaver Brook - bbah@beaverbrookah.com as a CC'd Recipient Ip: 98.175.158.97