INSULIN ADMINISTRATION RELEASE FORM:

I, _______________________________, owner of ______________________, acknowledge  the following amendments to my boarding contract with AFFORDABLE GROOMING & BOARDING, INC. as it pertains to my pet receiving Insulin medication during their boarding stay:

~          AFFORDABLE GROOMING & BOARDING INC. will charge a fee of $10.00 per day to administer Insulin injections to my pet.

~          AFFORDABLE GROOMING & BOARDING, INC. DOES NOT have the proper equipment to test my pet’s blood sugar level. 

~          AFFORDABLE GROOMING & BOARDING, INC. will not be held accountable if my pet is overmedicated and/or under-medicated due to increased and/or decreased sugar levels that they cannot test for and, therefore, cannot be aware of.

~          It is AFFORDABLE GROOMING & BOARDING, INC’S. policy that my pet must eat before scheduled Insulin injections can be administered. 

~          Every effort will be made on AFFORDABLE GROOMING & BOARDING INC’S. part to encourage my pet to eat (IE:  different foods, treats, etc.)

~          In the event that, despite all efforts, my pet still chooses not to eat, I understand that I will be contacted - and my consent must be given - at my own risk - before that scheduled Insulin injections will be administered.

~          I understand that AFFORDABLE GROOMING & BOARDING, INC. will watch for and/or note any changes in my pet’s diet, behavior, demeanor, and/or energy level and I will be notified immediately of any such changes.  My consent must be given before any alterations to my (previous) check-in instructions are followed.

I have fully read and I completely understand the content of this amendment to my boarding contract and I am willingly agreeing to such.

___________________________                   _____________________________ 

CLIENT:                                  DATE:                         AFFORDABLE SUPERVISOR: