Pet's Name *

Does your pet have any pre exisiting problems you would like us to be aware of? (lumps, bumps or coat changes.) *

Yes
No

If so, please explain. *

Any coughing, sneezing, or vomiting in the last 24 hours? *

Yes
No

Is your pet having regular urination and bowel movements? *

Yes
No

Is your pet eating and drinking well? *

Yes
No

Does your pet chew or tear up bedding? *

Yes
No

Multiple pet accommodation only

Does your pets need to be separated during feeding?

Yes
No

Do they have any history of aggression or agitation towards one another?

Yes
No

Feeding instructions:

If your pet is on a prescription diet, do we have permission to refill as needed? *

Yes
No
Not applicable

If your pet is NOT on a prescription diet, do we have permission to feed our house food if they run out? (GI sensitive formula) *

Yes
No
Not applicable

If your pet is reluctant to eat while here, do we have permission to add a small amount of house food (GI sensitive formula) to entice them to eat? *

Yes
No
Please contact me

Please tell us the amount and frequency you would like us to feed your pet. *

Medications:

Is your pet on any mediciation? *

Yes
No

If so, do we have permission to administer mediciation? *

Yes
No

Medication: *

Amount/Frequency: *

***There is a charge each time medications are administered***

OPTIONAL Extras: (indicate quantity)

Splash Time (summer only) - Your pet gets to splash around in a kiddie pool with one of our attendants supervising
Mountain Patio Playtime - Your pet will get extra time outside to play with toys or just soak up some sun
Cuddle Time - Your pet will have time set aside for individual attention and love
Romp in the Park - Your pet will enjoy a walk around the park with one of our attendants
Pillow Talk for Dogs
Nail Trim

Emergency Contact: *

Phone: *

Emergency Contact: *

Phone: *

In the event of an emergency, how would you like us to proceed? *

I would like to be contacted prior to any treatment
I would like Village Park to proceed regardless of cost
I would like Village Park to proceed with treatment up to the following amount

Maximum treatment cost *

Medication Administration Charge: I understand that there will be a fee based on frequency to administer medications to my pet. *

Yes I acknowledge

Medical Conditions: All current or medical conditions must be mentioned during each individual check in. *

Yes I acknowledge

Our pick up and drop off times are from 9 am to 7 pm Monday through Friday and 9 am to 4 pm on Saturdays. We are closed Sundays. *

Yes I acknowledge

Visitor consent: Village park will not allow visitors or release your pet to anyone other than you without your prior consent. *

Yes I acknowledge

Socialization: Pets are not socialized with other pets outside of their own family. *

Yes I acknowledge

Pet aggression: If a pet shows aggression towards any other family pet, Village Park will separate them when necessary to ensure the well-being of each pet. *

Yes I acknowledge

Fleas or ticks: If a pet is found to have fleas or ticks, Village Park will treat your pet accordingly and owner will be responsible for any charges incurred. *

Yes I acknowledge

Pet Abandonment: I understand that if I do not pick up my pet within 14 days of the original expected pick up date and have not extended the stay, I will give up my rights of ownership of said pet(s) to Village Park Animal Hospital. *

Yes I acknowledge

ROMP IN THE PARK RELEASE: I understand and give permission for the staff of Village Park Animal Hospital to walk my pet in the La Quinta Community Park during the duration of their stay at the Bed and Biscuit. I understand that my pet will be walked off the premises of Village Park Animal Hospital, but will be, at all times, on a leash and under control with one of the trained staff members. Village Park Animal Hospital will take every precaution to ensure the safety and security of your pet during their park walk. I understand this policy and will not hold Village Park Animal Hospital or any one of the staff members liable for any uncalculated circumstances that may arise, such as, but not limited to, my pet escaping off-leash, dealing with loose dogs in the park, etc. *

Yes
No, I do not give my consent

SWIM TIME RELEASE: I give permission for the boarding staff at Village Park Animal Hospital to let my pet play in a wading pool filled with water. I understand that my pet will never be left unsupervised while in the pool. I understand that some long-haired pets getting wet may cause hair to be curly and may matt. I also understand Village Park Animal Hospital Staff will take every precaution to not have this happen. Staff will not be liable if such circumstances arise. The pool will only be used during the summer. * *

Yes
No, I do not give my consent

Photo Release. May we have permission to put any pictures of your pet that we may get on out VPAH Facebook® page or website? *

Yes
No, I do not give my consent

Owner understands and acknowledges that Village Park Animal Hospital has agreed to render services as described herein based upon owners representations made on registration form. Owner agrees to pay Village Park Animal Hospital for all services rendered. In the event it is necessary to initiate collection proceedings on the account, owner will be responsible for all attorney’s fees, and cost of collection, and these fees will be added to the outstanding balance. *

Yes I acknowledge

By signing below, I acknowledge and agree to all the information stated above.

Owner's Name *

First

Last

Primary Contact Number *

Date *

Owner's Signature *

Multiple Choice

First Choice
Second Choice
Third Choice

BOARDING CHECK IN FORM