Boarding Check-In Form

Name of Emergency Contact & Phone Number*

Name:
Phone Number:

Pet's Name:*

You may take your pet out for the day between the hours of 9:00 am and 4:30 pm Monday through Friday. We will need a credit card number if you take them out for the day or will be picking up on Saturdays or Sundays when we are closed. The pickup time on Saturday and Sunday is 9:00 am or 5:00 pm. You will be charged and additional 1/2 day if you pickup after 12:00 pm.

Time of Pickup on the Weekend.*

Day:

9:00 am

5:00 pm

Credit Card Number:

Expiration Date:

CVC:

Zip Code:

Dogs need Rabies and DHLPP vaccinations within the last 12 months and a Bordetella (Kennel Cough) vaccination within the last 6 months.

Cats need a Rabies and FVRCP vaccine within the last 12 months.

There is a boarding exam charged for all animals that are not normally patients of Coastal Animal Hospital or for regular clients who haven't been seen within the last year. We will charge your account an additional $10.28 to verify vaccinations from your veterinarian. If your pet becomes ill while boarding, appropriate treatment will be initiated for which you are financially responsible. If your pet is found to have fleas, we will have to administer an oral flea prevention at your cost to keep our kennels flea-free.

There is a $6.86 charge per administration of medication for your pet. We take every precaution to ensure your animal is safe and secure, however in the event of an escape Coastal Animal Hospital will not be held reliable.

Please enter your name below to serve as your signature acknowledging that you have read, understand, and agree to the above-mentioned information and certify that your pet is current on its vaccinations.*

During hurricane season, Dare County may call for a mandatory evacuation of the Outer Banks. In this case, the kennels will be evacuated. You or your appointed representative will be required to pick up your pet. If you cannot be reached or are unable to pick up your pet, you agree to pay any additional fees incurred in the transport and housing of your pet. Coastal Animal Hospital will not be responsible for any injury to your pet during a hurricane. We may not be able to gain access to the hospital to care for your pet. Once the evacuation order has been lifted our kennels will reopen.

Please enter your name below to serve as your signature acknowledging that you have read, understand, and agree to the above-mentioned information and certify that your pet is current on its vaccinations.*

Will you be providing food or using ours? If providing food, please pre-package meals. *

How much do you feed?*

How often?*

AM

PM

Both

When was your pet last fed?*

Has your pet shown any recent signs of:*

Diarrhea

Coughing

Vomiting

Sneezing

Any unusual symptoms or signs that we should be aware of while boarding your pet? Please specify.*

Does your pet receive monthly Heartworm Prevention?*

Yes

No

Does your pet have any food allergies?*

Yes

No

Are we allowed to give our treats to your pet? Chicken and beef based.*

Yes

No

Is your pet on any medications?*

Yes

No

If you answered yes, that your pet is on medications, Please include the medication, concentration, how many pills/caps, how often, and when the last dose was given. *

Medication
How Much
How Often
Last Dose
Medication
How Much
How Often
Last Dose
Medication
How Much
How Often
Last Dose

Emergency Contact Information

Name of Emergency Contact & Phone Number*

Pet's Name:*

Boarding Requirements

Will you be providing food or using ours? If providing food, please pre-package meals. *

How much do you feed?*

How often?*

When was your pet last fed?*

Has your pet shown any recent signs of:*

Any unusual symptoms or signs that we should be aware of while boarding your pet? Please specify.*

Does your pet receive monthly Heartworm Prevention?*

Does your pet have any food allergies?*

Are we allowed to give our treats to your pet? Chicken and beef based.*

Is your pet on any medications?*

If you answered yes, that your pet is on medications, Please include the medication, concentration, how many pills/caps, how often, and when the last dose was given. *

Any belongings that you are leaving with your pet? Please list a description of items.*

Today's Date:

Day:
9:00 am
5:00 pm
Credit Card Number:
Expiration Date:
CVC:
Zip Code: