Daycare Form – Hoffman Animal Hospital

Name*
First Last
Pet's Name*
Has your pet stayed with us before?*
- Yes
- No
Phone*
Email*
Emergency Contact Information
Emergency Contact #1*
First Last
Phone*
Emergency Contact #2
First Last
Phone
Medications or Supplements
Do we need to give any medications or supplements during your pet’s stay? There is an additional charge for administration of each medicine dose. Please list your pets medicines: ***ALL MEDICATIONS NEED TO BE IN ORIGINALLY PRESCRIBED CONTAINERS****
If your pet requires medication, please list the medication name, dosage, and time of dosage below:
Medication Name Dosage Time of Dosage
Pet's Diet
Any treat restrictions?*
- Yes
- No
Does your pet need to be fed while in our care?*
- Yes
- No
If yes, please provide details:*
Playtime
Is your pet allowed to play with other pets while staying with us?
- Yes
- No
Any restrictions to the size of the other pet?
I understand and agree, if my pet has fleas or evidence of fleas, the hospital will administer a dose of Capstar® to my pet for a fee.*
I understand and agree
I understand our hours of drop off and pick up: Monday through Friday 7:30 am – 11 am or 1:00 pm -5:30 pm Saturday 7:30am – 1pm (We do not offer pick-up or drop-offs from 11 am to 1 pm Monday though Friday.)*
I understand and agree
I understand if I’m dropping off or picking up outside of these set hours, there will be a fee.*
I understand and agree
I understand that if I pick up by 11:00am, there is NO charge for that day. If I pick up after 11:00am, then I WILL be charged for that day*
I understand and agree
I understand and agree that payment for all services will be due and payable upon discharge of my pet. In the event of abandonment, defined as; a pet left, unclaimed, for ten days past the scheduled discharge date without owner communication, or unclaimed 30 days from the date of scheduled discharge without payment in full for all services. Unclaimed pets are surrendered to Anne Arundel County Animal Control, classified as an “abandoned pet”, and will no longer be the responsibility of Hoffman Animal Hospital, or any of its employees.*
I understand and agree
I understand that the guests are not supervised at all times, and if I request that two or more of my pets share one accommodation there is some risk of injury. My pets may be moved into separate accommodations if the situation is deemed unsafe, and I will be responsible for paying for the separate accommodations. I absolve Hoffman Animal Hospital and its employees and staff of any responsibility if my pets were to injure one another while here.*
I understand and agree
I UNDERSTAND THAT HOFFMAN ANIMAL HOSPITAL AND ITS BOARDING FACILITY IS NOT STAFFED 24 HOURS A DAY.
I understand that if my pet becomes ill during the boarding period our associate veterinarian will examine and provide treatment as required. I understand that I am responsible for any charges incurred. If the doctors deem it necessary to transfer my pet to the Anne Arundel Veterinary Emergency Clinic for hospitalization or care, I understand and agree that I will be responsible for all expenses incurred. Hoffman Animal Hospital will try to contact me and /or my emergency contact should my pet become seriously ill while boarding.*
I understand and agree
Name*
First Last