Vet Clearance Form



Vet Clearance Form

3333 Hwy. 7, Norwood, ON. K0L 2V0

Tel: 705-639-8964 Fax: 705-639-8917

This form must be completed in full before your pet’s stay as our guest. Please complete the form and include copies of your current vaccination records.

Dog Owner’s Name:_______________________________________

Dog’s Name:____________________________________________

Breed:_____________ DOB (or approx. age):__________ M/F ___

Veterinarian:____________________ Phone:_________________

Address: _______________________ Fax:___________________

If you are able, please have your Vet read over the following letter and sign.

I would like my dog to be a guest at English Farm Boarding Kennels while I am away and to participate in their canine activities while they are enjoying their holiday. Please provide English Farm Boarding Kennels with the following information by faxing this form to them at 705-639-8917, at your earliest convenience.

I understand and agree that if my dog becomes injured or ill, English Farm Boarding Kennels shall have the right to call a Veterinarian designated by me, or to call a Veterinarian chosen by the English Farm Boarding Kennel, or to administer medicine or give other advisable attention, or to obtain information about the dog at any time, within the discretion and judgment of the Kennel.

a) If my dog needs medical treatment, I agree to reimburse the Veterinarian/English Farm Boarding Kennels for services rendered for the following:

1. For all costs he/she deems necessary to make my pet well OR

up to a maximum of $_________.

2. If my dog is suffering from a terminal illness or injury, English Farm Boarding Kennels will attempt to contact me first; however, if I cannot be reached and my dog is suffering I give permission to the Veterinarian to euthanize them, trusting their professional discretion.

Thank you.

Sincerely,

_________________ ________

Signature of pet owner Date

_____________________ _______

English Farm Boarding Kennels Date

Vaccination Date Administered

Rabies:_______________ ______________

DHLPP:______________ ______________

Bordatella:____________ ______________

Parvovirus:____________ ______________

Flea Prevention:________ ______________

Spayed/Neutered Yes or No

Other medical information English Farm Boarding Kennels should know about my dog:

____________________________________________________________________________________________________________________

____________________ __________________

Signature of Veterinarian Date

Customer Agreement Form

1. English Farm Boarding Kennels (herein after called “Kennel”) agrees to exercise due diligence in the care of my dog/cat. In addition English Farm Boarding Kennels agrees to keep its premises clean and sanitary. My dog/cat will be cared for by Kennel staff or English Family members only, without liability on the Kennels part for loss or damage including but not limited to disease, theft, fire, death, escape from fenced areas, injury or harm to persons, other dogs/cats or property by my dog/cat, due diligence and care having been exercised by English Farm Boarding Kennels. The Kennel shall exercise reasonable care for the animal while boarding, however, it is expressly agreed that the Kennel’s liability shall in no event exceed the lesser of the current chattel value of a pet of the same species or the sum of $50.00 per animal boarded. I further agree to be solely responsible for any and all acts, damage, or behavior of said pet while it is in the care of the Kennel.

2. I agree to pay the boarding rate in effect on the date my dog/cat is checked out of the English Farm Boarding Kennel, as well as for any additional services requested or rendered. These costs shall be payable upon the pick-up of my pet. I agree that the pet shall not leave the Kennel until all charges are paid to the Kennel. I agree that the Kennel shall have, and is hereby granted, a lien on the pet for any and all unpaid charges resulting from boarding my pet at the Kennel, including abandonment of the animal. I agree that in event that the boarding charges are not paid when in accordance with this contract, the Kennel may exercise its lien rights upon ten days written notice by certified mail.

3. I understand and agree that, if I do not pick up my dog/cat from the Kennel at the agreed upon date & time, and I have not contacted the Kennel to arrange an alternate time to pick up my dog/cat, The Kennel will consider my dog/cat abandoned and will turn my dog/cat over the Peterborough Humane Society.

4. I understand and acknowledge that animals can be unpredictable in behavior and may cause damage to property, people, or other animals for which the Kennel could be held liable. I agree that I am solely responsible for any damage or harm to property, people, or other animals caused by my dog/cat while under the care of the Kennel. I hereby agree to indemnify English Farm Boarding Kennel for any and all claims resulting from the actions of my dog/cat. I understand that I am solely financially responsible, including Veterinarian charges required, for any damage or harm caused by my dog/cat while under the care of English Farm Boarding Kennels.

5. Should my dog/cat become ill or seem to be in need of medical attention, English Farm Boarding Kennels, in its sole discretion, reserves the right to administer aid and/or to engage the services of any available veterinarian. My dog’s/cat’s personal veterinarian will be contacted first, but if not available, the Kennel’s vet will be contacted. I shall pay any expenses incurred as a result of this medical attention. The Kennel will not be held responsible for any disease or illness contracted by the pet during its stay. I have completed a Vet’s Clearance Form as requested.

• Note: I have____ or have not____ left my credit card number and authorization with my veterinarian to apply necessary fees incase of an emergency. (Please initial where applicable)

6. My *dog/cat is in good general health and valid proof that he/she is current on Rabies, *BHLPP, *Bordatella and *Parvovirus vaccinations will be provided before he/she can stay at the Kennel. In addition my dog is on a scheduled flea/tick prevention program. Pets arriving with fleas and/or ticks will be bathed at owner’s expense.

7. Should my dog/cat exhibit inappropriate aggressive behavior toward other animals or people, for the safety of all concerned, he/she will be placed in a secure run/cage separate from other animals.

8. I understand and agree that, if English Farm Boarding Kennels deems within its discretion and judgment that my dog/cat cannot safely adapt to the boarding care provided by the Kennel, that the Kennel shall have the right to place my dog/cat in another kennel of its choice at my expense.

9. English Farm Boarding Kennels reserves the right to refuse any dog/cat.

I have read and understand and agree to the terms above. This contract will be kept on file and will be valid for one year from the date below.

Signature of Owner Printed name of Owner

Dog’s / Cat’s Name Date

________________________________________________________________________________________________English Farm Boarding Kennel Representative Date

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