Boarding Form – Rocklin Road Animal Hospital

Boarding Reservation Request Form

Thank you for choosing our Boarding Facilities!

Our facilities will allow your pet to be as comfortable as possible while you are away. Please feel free to contact us for a tour of our facilities at any time. Please do not assume your boarding arrangements are confirmed until we have contacted you to confirm the requested dates.

IMPORTANT: Boarding dates and arrangements are not confirmed until you have received notification. A staff member will contact you by phone or email.

Name*
First Last
Email*
Phone*
Which pet(s) would you like to board?*
- Dog(s)
- Cat(s)
- Both
How many pets would you like to board?*
Pet(s) Name(s)*
Have you used our boarding services before?*
- Yes
- No
Drop off Date*
MM
DD
YYYY
Drop off Time*
: HH
MM
Pick-up Date*
MM
DD
YYYY
Pick-up Time*
: HH
MM
I, the undersigned, do hereby consent and agree that Rocklin Road Animal Hospital, its employees, or agents have the right to take photo, videotape, or digital recordings of my above-listed pet(s) and release all rights to exhibit this work in print and electronic form publicly or privately. I also understand that Rocklin Road Animal Hospital is not responsible for any expense or liability incurred as a result of my, or my pet(s) participation in any photos and/or recordings.*
- Accept
- Decline
Signature of Owner/Agent
I hereby authorize the staff at Rocklin Road Animal Hospital to examine, prescribe for and treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this/these animal(s). I also understand that all charges will be paid at the time of release of my pet and that a deposit may be required before treatment.
First Last
Date
Date Format: MM slash DD slash YYYY

Boarding Reservation Request Form

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