SENIOR PET RELEASE FORM

Your pet is very important to us and, because their welfare is our top priority, we want to assure you that every effort will be made to make their stay with us as safe, comfortable and routine as possible.

However, when older pets are boarded, their bodies are subjected to unforeseen stresses because their normal routine is disrupted when they are removed from their home environment.  This stress has the potential to cause many latent physical conditions (i.e. heart, liver and kidney disorders) to become active and potentially life-threatening.

Although every effort will be made to contact you first, in the best interest of your pet, we request your permission to obtain medical care should a situation arise that we feel warrants immediate veterinary assistance.  Should we be unable to speak with you personally, please indicate below what measures you would like us to take on your behalf:

_____  Make every effort possible to save pet’s life     

_____  Make no heroic measures to save pet’s life                                           

_____  Maximum dollar amount to spend for veterinary care: $_________________

_____  Treat my pet as needed BUT with these restrictions: _______________________

Pet’s Name: ______________________________    Age: ___________      Sex: _______

Breed: __________________________________     Veterinarian: __________________

Current Health Status: _____________________        Medications: __________________

Current Health Concerns: ____________________________

Other problems/concerns we should be aware of: _______________________________

 ______________________________________________________________________

I have read the above noted agreement and fully understand it’s terms and conditions.  I agree not to hold AFFORDABLE BOARDING & GROOMING, INC., owners Al & Kerry Jones or any staff members responsible for any unforeseen or unexplained age-related illness or death of my senior pet while he/she is in their care. 

Owners Signature: __________________________________           Date: __________

Owner (print): _____________________________    Home Phone: _______________