Special Needs and Geriatric Canine Boarding Check In

Filling out this form does not create a reservation. Reservations must be made via phone at 970-226-6526.

First Name *

Last Name *

Pet(s) Name *

Phone Number *

Email Address

Check In Date *

Check Out Date *

Accommodations

Choose your pets accommodations *

Level 1 - $51 per day, $18 per additional dog in same run. * Minimal or no medical issues with up to 2 oral medications.

Level 2 - $54 per day, $21.25 per additional dog in same run. * Moderate medical issues, rewuired frequent treatments (i.e. bandage changes, hand feeding, etc), 3- 5 oral medications.

Level 3 - $58.25 per day, $26.50 per additional dog in same run. * Advanced medical issues/Diabetic boarding. Requires frequent treatments (i.e. bandage changes, hand feeding, etc), more than 5 medications.

*Additional dogs boarding in the same kennel may be approved on a case-by-case basis

Additional Amenities *

Kong filled with peanut butter - $2 per day

Kong filled with canned food - $2 per day

Yard Time - $4.75 per day or $7 per family - $4.5- per day or $6.50 per family

Extra TLC - $5.25 per day

No additional amenities

Feeding Instructions

What Kind? *

Our food (Purina Pro Plan Gastrointestinal Low Fat)

Your pets own food (specify brand below)

Own food brand:

When should we feed your dog? (Check all that apply) *

Morning

Noon

Evening

How much should we feed your dog? *

Does your dog have food sensitivities or allergies? (If yes, specify below) *

Yes

No

What are your dogs food sensitivities or allergies?

*We may need to use our canned food to encourage your pet to get enough to eat during their stay or if your pet runs out of food while they're with us.

Medication Instructions

Medication #1:

Dosage:

When should we give your dog this medication? (Check all that apply

Morning

Noon

Evening

Medication #2:

Dosage:

When should we give your dog this medication? (Check all that apply

Morning

Noon

Evening

Medication #3:

Dosage:

When should we give your dog this medication? (Check all that apply

Morning

Noon

Evening

If there are any additional medications, please specify:

Please list any Health or Medical Concerns/Special Procedures or Instructions: *

Emergency contact name: *

Emergency contact phone number *

Regular veterinarian *

Please Read and Accept *

I understand that I will be charged for a full day of boarding on the day of drop-off and pick-up, unless I pick my pet up before 11:00 am Monday-Saturday, and I will always be charged for a full day of boarding on Sunday. I agree to pay in full with cash or credit card (we do not accept checks) at the time of pick up.

Please Read and Accept *

By signing this release, I certify that my dog has been medically approved by South Mesa Veterinary Hospital/Come-Play-Stay! to board in Special Needs. I am aware that, once in Special Needs boarding, dogs that are not eating, or otherwise doing poorly, will be hospitalized at the my expense.

Please Read and Accept *

Reasonable precautions will be taken against communicable disease, illness, injury, escape, or death of this pet. South Mesa Veterinary Hospital/Come-Play-Stay and staff will not be held liable for problems that might develop provided reasonable care and precautions are followed. I agree that any medical problem that develops with my pet will be treated as necessary in accordance with routine procedures and I assume full financial responsibility for all such treatments. A South Mesa Veterinarian will make every attempt to contact me in the event that my pet needs medical attention. As required by the Colorado Department of Agriculture, PACFA Regulations, Description 16.00 G. 3., in the event of death, the facility will provide interim body care (cold storage at South Mesa Veterinary Hospital) until the owner is reached and final plans are made. I assume full financial responsibility for all medical treatment my pet needs, even if I cannot be contacted. South Mesa Veterinary Hospital/Come-Play-Stay is not liable for the loss, damage or destruction of personal belongings.

Release For Pets Under 6 Months of Age

I understand that, due to the young age of my pet, it may be more susceptible to disease as its immune system has not been completely developed.

Digital Signature Agreement. Please enter your name. *

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Canine Special Needs Check In Form

Special Needs and Geriatric Canine Boarding Check In

Accommodations

Feeding Instructions

Medication Instructions

New Patients Welcome

Canine Special Needs Check In Form

Special Needs and Geriatric Canine Boarding Check In

Accommodations

Feeding Instructions

Medication Instructions

New Patients Welcome

Notice of Temporary Closure - Come Play Stay Boarding & Grooming