"*" indicates required fields Pet's Name Date MM slash DD slash YYYY Best Email Emergency Contact Name Phone #Boarding From Date MM slash DD slash YYYY Boarding From Time Hours : Minutes AM PM AM/PM Boarding End Date MM slash DD slash YYYY Boarding End Time Hours : Minutes AM PM AM/PM Pick-Up PolicyAlthough you are free to pick up your pet anytime between 8am - 12pm and 2pm - 4:30pm Monday-Friday, any pick ups after 2:30pm will incur a Half-Day Daycare fee. I certify that I have read and understand the ACM/ Pet Hotel of Milford pick up policy.My pets will be boarding* Separately Together Do we need to separate their feedings?* YES NO Will you be providing your pet's food from home?* YES NO What's the name of the food? ListFeeding TimesHow Much?Last Fed? Add Remove(please label food and bowls to minimize the risk of lost items)Any special instructions?Medications/Supplements: (Please be specific with names and directions on when and how they are given. There is an additional charge of up to $20 per night if a patient needs medications, this charge will be added to your invoice.)Name of MedicationDirectionsLast Given Add RemoveBEDDING: The Animal Clinic of Milford/ Pet Hotel of Milford does not recommend bringing beds and blankets from home to leave with your pet for boarding due to the risk of loss and/ or damage due to high volume of cleaning and difficulty in labeling and the risk of foreign body from chewing, shredding, and/ or eating due to stress and other factors. However, if you do decide to bring in bedding from home we will do our best to keep track of your bedding but we cannot be held responsible in the case of loss or damage of any personal bedding nor in the case that your pet needs surgery to remove foreign bodies resulting from chewing, shredding, and/or eating any type of bedding. By signing this document you release the Animal Clinic of Milford/ Pet Hotel of Milford from any and all responsibility that may result from bringing personal bedding in with your pet who is boarding and you understand and support the conditions stated above.* INITIAL**Does your pet(s) chew/shred/eat any type of bedding?* Yes No **Will you be providing a personal bed/ blanket for your pet?* Yes No WALKS & PLAYTIMES: UP TO four (4) walks and at least one (1) play session per day is included in your pets boarding stay, depending on the volume of residents and weather on any given day. You may elect for your pet to have more walks/ playtime for an additional cost and we will do our best to accommodate your request. If we are unable to fulfill your request in its entirety, a refund (to the orginal card you paid with) will be issued for the difference at the time of pick up. PHOTOS: We will do our best to send you pictures of your pet's stay at the Pet Hotel of Milford. However, when boarding volume is high, our number one priority is to make sure all residents are cared for properly, so that they remain happy and healthy during their stay. Therefore, please understand that pictures are not guaranteed, given the number of residents we may have in our care.SOCIAL MEDIA: The Animal Clinic of Milford/ Pet Hotel of Milford occasionally take photos of the residents of the Pet Hotel and we would love to share your pets stay on our Social Media platforms. Do you grant the Animal Clinic of Milford/ Pet Hotel of Milford permission to post your pets photos on our social media, website, and to use your pets photo in marketing material (when applicable)?By granting permission to use photos of your pet, as stated above, you relinquish all ownership and rights for these photos to the Animal Clinic of Milford/ Pet Hotel of Milford.* Yes No VACCINATIONS: For the safety of all our patients, ACM requires all boarders to have proof of current vaccinations. If your pet is not current on the all health vaccinations, they will be given the required vaccines upon arrival at ACM/ Pet Hotel of Milford at your expense, this will include an exam fee. We reserve the right to turn away any boarder more than 30 days past due for vaccines. I certify that I have read and understand the vaccine requirements and that my pet(s) are current on all required vaccinations for boarding: DOGS: Rabies, Distemper, Bordetella, Parainfluenza, Parvovirus, Leptospirosis, and Canine Influenza. CATS: Rabies, Rhinotracheitis, Calicivirus, Pneumonitis, Feline Distemper, and Panleukopenia. Health History: Please provide the following information regarding your pet’s health history: Does your pet suffer from any of the following conditions? Heart Disease Respiratory Disease Seizures Allergies Arthritis Please list any other medical conditions your pet has or any special care that your pet(s) may need.FECAL EXAM: Due to the infectious nature of intestinal parasites, a negative fecal result must be obtained prior to boarding and is required every 6 months. If your pet does not have a current negative fecal, ACM/ Pet Hotel of Milford will obtain and send one out upon arrival for boarding. If your pet is positive for intestinal parasites, the appropriate medication will be instituted or dispensed to you. The charges for both the medication and fecal exam will be added at your expense.* I certify that I have read and understand the policy on fecal exams at ACM/ Pet Hotel of Milford. Is your pet current on flea/ tick prevention? I* Yes No If the staff of ACM/ Pet Hotel of Milford sees or suspect your pet of having fleas and/ or ticks, they will be treated at your expense.Has your pet been recently anesthetized or had a procedure done in the past 14 days?* Yes No Please Explain:*Does my pet have any behavioral issues?* YES NO Please explain:Does my pet need to be separated from other boarders in our facility?* YES NO AMENITIES* I understand that the following list of items can be obtained during my pets stay here at additional costs to my final bill. Please check next to the items below if interested in those services BATH ONLY(SM: $37, Med: $47, LG: $58, XL: $69, cost does not include Taxes & are subject to change) NAIL TRIM ONLY ($20.47 +Tax, subject to change) BATH & NAIL TRIM (Charged separately based on current costs +Tax) ADDITIONAL PLAY TIME ($10 per session +Tax) ADDITONAL WALKS ($10 per walk +Tax) Puppuchino ($2.00 per treat +Tax) Frosty Paws ($3.00 per treat +Tax) HOW MANY ADDITIONAL PLAYTIMES?* HOW MANY ADDITIONAL WALKS?* HOW MANY ADDITIONAL PUPPUCHINOS?* HOW MANY ADDITIONAL FROSTY PAWS?* POOL TIME The Animal Clinic of Milford/ Pet Hotel of Milford are now offering Pool Time during the summer months and if weather permits. During Pool Time your pet will get wet, the Animal Clinic of Milford/ Pet Hotel of Milford will dry your pet after each pool session however, your pet is at risk of contracting skin, eye, and/ or ear irritations/ infections such as, but not limited to, hot spots. Please initial below, whether you would like your pet to receive Pool Time and that you understand and accept the terms of this service as stated below. Pool Time* YES NO HOW MANY POOL TIMES?* ($5 per session +Tax)I understand and accept that if I elect for The Animal Clinic of Milford/ Pet Hotel of Milford to give my pet Pool Time that they are at risk of contracting skin, eye, and/or ear irritations/ infections such as, but not limited to hot spots. I do hereby release The Animal Clinic of Milford/ Pet Hotel of Milford from any and all responsibilty that result from electing Pool Time services for my pet.* InitialHOSPITAL SERVICES *I understand that ACM will do everything possible to ensure your pet has a safe, happy, healthy stay at our amazing Pet Hotel. Although your pets are closely monitored during their stay and all play/social times, there is always a risk of illness due to stress, among other factors, and/or injury due to active play, rough housing, and altercations with our boarders. We will bring the ill or injured pet to our hospital side of our facility upon your request. If you are unable to be contacted using the emergency contact phone number listed in the waiver, our doctors will use their best judgment to treat any illnesses and/ or injuries that may be at the cost of the owners. In the event that your pet becomes ill and/ or injured on a day that ACM is closed (Sundays and some holidays) and one of our doctors is unable to exam them, we will transfer your pet to an emergency hospital upon your request. You, the pet owner, are resposibility for any and all costs incured by your pets visit to the ER.* InitialSignature*Date* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.