Boarding Agreement Form

Save time during your pet’s boarding appointment. Complete your required boarding agreement form online before your visit.

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Boarding Agreement Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

Personal Items

Owner's Name *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Emergency Contact

Phone *

Dropping off Date *

Pick up Date *

Animal's Name

Species

Breed

Color

Age

Sex

Spayed/Neutered

Animal's Name

Species

Breed

Color

Age

Sex

Spayed/Neutered

Animal's Name:

Species

Breed

Color

Age

Sex

Spayed/Neutered

Current on Vaccinations? (Rabies, Distemper, Bordetella are required). *

Clinic used for vet care (if not Roland Vet Clinic) *

Has your pet/pets been ill the last 5 days? *

Diarrhea
Vomitting
Coughing

Food Information *

Canned
Dry
Refrigerated

How much of food per feeding *

Special Diet? *

Medications Required? (If so please be specific! As to name of medication, when to be given, etc.) *

Special Instructions

I understand that if my pet has fleas, tick, or other parasites he/she will be treated at my expense. This is to ensure the safety of all patients at Roland Veterinary Clinic. *

Clear Signature

Payment is due in full at the time of that services are rendered. Your pet will be boarded until payment is received in full. (Canine $25/day, Feline $15/day) *

Clear Signature

Reasonable precaution will be used against injury, escape, or death of this pet. The clinic and staff will not be held liable for problems that develop provided reasonable care and precautions are followed. I understand that any problem that develops with my pet will be treated as deemed best by the staff veterinarians and I assumes full responsibility for the treatment involved.

Signature of Owner/Responsible Party *

Clear Signature

Personal Items

Kennel # *

Animal Name *

Animal Description *

Medication

Add 2nd Pet Medication

Boarding Agreement Form

Boarding Agreement Form

Personal Items

Personal Items

Medication

Big or small

Proudly Serving the Pets of Roland, IA, and Beyond

Big or small

Proudly Serving the Pets of Roland, IA and Beyond

Big or small

Proudly Serving the Pets of Roland, IA and Beyond

Have a Question?

Location

Clinic Hours

Contact Information

Boarding Pickup & Drop-Off Times