Animal’s Name *

Owner’s Name *

First

Last

Email *

Phone Number *

Pricing: $22 per day for dogs ($39 per day with play package) and $20 per day for cats. Luxury Suites are $31 per day, $48 with the play package.

Please note: We cannot guarantee Wi-Fi access.

NOTE: Pets requiring injections, controlled substances, or oral medications will be charged an additional $3–$5 per day. Charges begin on the day of drop-off.

If your pet is picked up before 10:00 AM, you will not be charged for that day.

In case of an emergency, we will first attempt to contact the owner(s) listed above. If we are unable to reach you, please provide an alternate emergency contact.

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Would you like text updates? (M/W/F) *

Yes
No

List phone number for text updates

With Play Package: (MUST PASS ASSESSMENT FIRST) *

Yes
No

The play package involves daycare with a group of other pets when space is available during your pet’s boarding stay. If an assessment has not already occurred or it has been over a year since the last assessment, another assessment will be required to participate.

Dates Boarding:

Drop-off date: *

Pick-up date: *

Please choose an approximate pick-up time:

Monday – Friday: *

Saturday: *

Sunday/Holiday pickup: *

8am-9am
9am-10am
3pm-4pm
4pm-5pm

Does your pet require any medical attention or additional care while boarding?

Yes
No

If yes, please explain:

Please list and describe all items you are leaving with your pet:

Food/Treats

Bedding

Medications

Toys/Miscellaneous

Please note: If you provide your own bedding, your pet may chew on or soil these items. We will launder them for you; however, this might mean they are not ready for you on the day you pick up your pet. Also, we are not responsible for any damage to these items.

Please note: If you provide your own toys, chews, or any other miscellaneous items, we are not responsible for any damage to these items. Furthermore, if the item causes a medical problem with your pet, we will treat it appropriately, and you will be financially responsible.

Is your pet on any daily medications? *

Yes
No

If yes, please describe below.

Additional comments:

Diabetic Boarding Pets:

I understand that if my pet does not eat on their own during their stay, the staff at Appleseed Valley Vet Veterinary may periodically check the blood glucose levels by blood draw in order to safely and effectively administer insulin.

I have read, understand, and agree to the above statement.

If you are boarding more than one pet, can they be housed together for the duration of their stay? (excludes feeding time) *

Yes
No

Feeding Instructions: *

Kennel Food (Science Diet Adult)
Own Food (Please portion for correct number of meals)

Amount *

How many times daily: *

Any other special instructions or comments?

I understand that Appleseed Valley Veterinary Hospital utilizes Science Diet Adult Dry food for pets while boarding and if my pet requires any additional/specific foods while here I will either provide them or understand that I will be charged for these foods while the pet is in the care of Appleseed Veterinary Hospital, Inc. *

I have read, understand, and agree to the above statement.

I understand that photographs, video, or digital recordings are taken of the facility, pets, customers, and staff on a regular basis for, among other things, use in advertising and social media. I acknowledge that all such images, together with prints and copyrights therein are the property of Appleseed Valley Veterinary Hospital, *

I have read, understand, and agree to the above statement.

I understand that boarding animals can be very stressful, even for the most accustomed and tolerant animals. As a result, temporary GI issues (upset stomach, diarrhea, lack of appetite, etc.) may arise from the high stress environment. *

I have read, understand, and agree to the above statement.

Please Note: Food should be pre-portioned in disposable bags for the number of days they are boarding.

I will be boarding my pet with Appleseed Valley Veterinary Hospital. My pet has had no vomiting, diarrhea or coughing within the last 14 days as well as I agree to withhold my dog/cat(s) from this program until he/she has been free of any signs of communicable disease within the last 14 days. __________ (Owner Initial) I have informed Dr. Hittinger and/or his staff of all medical and behavioral problems of which I am aware. *

I have read, understand, and agree to the above statement.

I have informed Dr. Hittinger and/or his staff of all medical and behavioral problems of which I am aware. My pet has no transmittable diseases or parasites of which I am aware. *

I have read, understand, and agree to the above statement.

I understand that there have been cases of Upper Respiratory Infection here and surrounding dog facilities over the past couple years. I understand that there is a risk to my pet of potentially contracting an Upper Respiratory infection during their stay. I assume responsibility for any medications needed to treat said infection. *

I have read, understand, and agree to the above statement.

In the event of illness or accidental injury to my pet during his/her stay at Appleseed Valley Veterinary Hospital I authorize Dr. Hittinger to administer appropriate, reasonable care and I agree to be financially responsible holding Dr. Hittinger and/or his staff and Appleseed Veterinary Hospital, Inc. harmless for same. *

I have read, understand, and agree to the above statement.

Flea/Tick Preventative

Flea/Tick Preventative Type *

Flea/Tick Preventative Date Applied *

such has (M/W/F)

Please Note: If your pet is found to have fleas or intestinal parasites while in our care, we will administer the necessary preventative treatment and add the cost to your bill. We will attempt to contact you at the number listed above before applying a different flea/tick preventative than the one already given this month. If we are unable to reach you, we will administer Capstar every 24 hours during your pet’s stay (at a cost of $8–$9 per dose).

Owner Signature *

Clear Signature

Date *

Boarding Intake Form