400 Bethlehem Rd.  Paris, KY 40361
(859) 987-6721

BOARDING RELEASE FORM
Date: __________
Name:  ________________________________________________						
Address: _______________________________________________
City: __________________  State: __________  Zip: ___________
Phone: ______________________

Thank you for allowing us the opportunity to care for your pet.   Like you, our greatest concern is the well-being
of your pet.  So that we may become better acquainted, please take the time to complete the following:

Emergency Contact _________________________________________   Phone__________________________________

Arrival Date: _____/_____/_____ Depart Date: _____/_____/_____ What time do you plan to pick up your pet? ________

MEDICATION:  Is the animal currently taking medication? ___ NO___YES____________________________________
**Pets requiring daily medication will incur a minimal additional fee.**                       List medication and how often it is given

FEEDING:  All boarded animals will be fed Science Diet unless specified otherwise.
Did you bring food for your pet? _____ NO _____ YES __________________________________________________
							         Name of food and how often you feed your pet.            	
VACCINATIONS:  The following vaccinations are required to be current prior to boarding:  Rabies, Distemper/Parvo, 
and Bordetella for dogs; Rabies, FVRCP, feline leukemia for cats.
If vaccines are not current, they will be administered at the owner’s expense.

Date of last vaccinations:_________________ Clinic Name: ___________________________ Phone:_________________

INTESINTAL PARASITES:  All pets are required to have a negative fecal test for intestinal parasites within 6 months prior to boarding.  Pets that are given a monthly heartworm preventive that contains a comprehensive dewormer are exempt.
If not current on intestinal parasite control, pet will be tested in the clinic and dewormed if necessary at the owner’s expense.
Date of Last Fecal:  ___________ Is your pet on monthly heartworm preventive? ___No ___Yes ______________________
												Brand
FLEA CONTROL:  Any pet that is admitted for boarding that is infested with fleas and/or ticks will be treated at owner’s 
expense.  Is your pet currently using monthly flea control? ___No ___Yes _______________________________________
										Brand			Date Applied
ILLNESS:  Has your pet shown any recent signs of the following:  ○ Diarrhea  ○ Vomiting ○ Sneezing ○ Coughing         
						 ○ Other ____________________________________________________

BATHING:  Would you like your pet to have a bath?  _____ YES _____ NO	 (Additional Charges Apply)
A complimentary bath will be given to your pet if he/she boards five or more days.  _____ Accept  _____Decline

In cases of illness or injury, I, the undersigned, do hereby give my consent for the veterinarians of Central Kentucky Veterinary Services to 
treat, prescribe for, or operate on my pet(s) while they are boarded at Central Kentucky Veterinary Services. I am responsible for all fees 
incurred by such services.

You are to use all reasonable precautions against illness, injury, or escape of my pet, but will not be held liable or responsible in any manner, 
or circumstances, on account of care, treatment, or safe keeping of my pet, as it is thoroughly understood that I assume all risks.

Should circumstances arise that my pet remains unclaimed after the date, which I have stated as the pick-up date, I understand that written 
notice will be mailed to the address above.  Seven days post written notice, the pet(s) will be considered abandoned and may be disposed of, 
or destroyed, as Central Kentucky Veterinary Services deems best.  It is further understood that such action will not relieve me from paying 
all costs of service and use of the hospital, including all costs of boarding.

**An extra fee will be added for animals requiring special handling.**

Please check and describe any other items brought with your pet:      ○ Treats ______________________    
○ Bedding ________________________  ○ Toys ___________________  ○ Other_______________________________
Additional Comments/Requests__________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

Signature of Owner _______________________________________________ Date __________________________