Daycare Consent Form "*" indicates required fields Step 1 of 32 3% PhoneThis field is for validation purposes and should be left unchanged.Client InformationPlease provide the information below as completely as possible. All information is strictly confidential. If your reservation is for a holiday or around a holiday please call for reservations Name* First Last 1st Emergency Contact Number*2nd Emergency Contact Number Pet InformationPlease limit the personal items you bring while your pet is staying with us to 1 special toy. JAH provides bedding for pets whose pet parents approve of bedding. If your pet is on a special diet, you may bring that food & written feeding instructions; otherwise, our hospital provides a prescription diet that is soothing to the GI tract for pets to eat while boarding.* I understandI understand that if pet has soiled themselves, the team at Johnston Animal Hospital will give a necessary freshening bath. I understand that I will be charged an additional fee for this treatment.* I understand Pet's Name*Additional Services**Note: A health care plan will be made for you to review at drop off for the services you have selected. No additional services Express anal glands Clean ears Clip nails File nails Does your pet have one special item you are leaving with them?* Yes No Please list the one special item you are leaving with your pet:* Is this pet on any medication that will need to be given during their stay?* Yes No Please list the medication(s) & instructions below:* Does your pet have their own food you will be leaving?* Yes No Please give feeding instructions below:*Include amount and frequency Does your pet have any allergies?* Yes No Please explain your pet's allergies:* Is your pet kennel aggressive?* Yes No Please explain your pet's kennel aggression:* Do you have a 2nd pet that will be staying for the day with us?* Yes No 2nd Pet's Name*Additional services for your 2nd pet**Note: A health care plan will be made for you to review at drop off for the services you have selected. No additional services Express anal glands Clean ears Clip nails File nails Does your 2nd pet have one special item you are leaving with them?* Yes No Please list the one special item you are leaving with your 2nd pet:* Is your 2nd pet on any medication that will need to be given during their stay?* Yes No Please list the medication(s) & instructions below:* Does your 2nd pet have their own food you will be leaving?* Yes No Please give feeding instructions below:*Include amount and frequency Does your 2nd pet have any allergies?* Yes No Please explain your pet's allergies:* Is your 2nd pet kennel aggressive?* Yes No Please explain your pet's kennel aggression:* Do you have a 3rd pet that will be staying for the day with us?* Yes No 3rd Pet's Name*Additional services for your 3rd pet:**Note: A health care plan will be made for you to review at drop off for the services you have selected. No additional services Express anal glands Clean ears Clip nails File nails Does your 3rd pet have one special item you are leaving with them?* Yes No Please list the one special item you are leaving with your 3rd pet:* Is your 3rd pet on any medication that will need to be given during their stay?* Yes No Please list the medication(s) & instructions below:* Does your 3rd pet have their own food you will be leaving?* Yes No Please give feeding instructions below:*Include amount and frequency Does your 3rd pet have any allergies?* Yes No Please explain your pet's allergies:* Is your 3rd pet kennel aggressive?* Yes No Please explain your pet's kennel aggression:* Do you have a 4th pet that will be staying for the day with us?* Yes No Your 4th Pet's Name*Additional Services for your 4th pet:**Note: A health care plan will be made for you to review at drop off for the services you have selected. No additional services Express anal glands Clean ears Clip nails File nails Does your 4th pet have one special item you are leaving with them?* Yes No Please list the one special item you are leaving with your 4th pet:* Is your 4th pet on any medication that will need to be given during their stay?* Yes No Please list the medication(s) & instructions below:* Does your 4th pet have their own food you will be leaving?* Yes No Please give feeding instructions below:*Include amount and frequency Does your 4th pet have any allergies?* Yes No Please explain your pet's allergies:* Is your 4th pet kennel aggressive?* Yes No Please explain your pet's kennel aggression:* Daycare Drop-Off Date:Drop Off Date* MM slash DD slash YYYY Being away from home can be a stressful experience for some pets. In the event of a non-life threatening matter with your animal would you like to be contacted before treatment is given?* Yes No Would you like us to use the emergency contact listed at the beginning of this form?* Yes No Please list the number you would like to be called in the event of a non-life threatening matter* Do you have any questions?* Yes No Please share with us any question(s) you have Please read and signI understand that if my pet enters Johnston Animal Hospital with fleas or ticks that my pet will be treated at my expense. I also understand that if my pet has soiled themselves, the team at Johnston Animal Hospital will give a necessary freshening bath at my expense. All vaccinations and exam must be current. Lastly, I understand that if my pet(s) exhibit signs of aggression, I will be responsible for an additional nightly fee, per pet, at my expense. I also understand that, at JAH’s discretion, if my pet(s) exhibit signs of aggression during boarding, they may not be permitted to schedule future boarding reservations.Client Name*Client Signature*Date* MM slash DD slash YYYY
