Name of Animal

Name of Owner(s)

Type of Animal

Date of Stay:

This is an agreement that is between Pittsfield Veterinary Hospital Inc. d/b/a Shaker Hill Pet Resort (“SHPR”) and the pet owner whose name and signature (“Owner”) appears below.

1. The Owner agrees to pay the per diem rate (then in effect) for said pet’s room and board at SHPR, in addition to any and all collection costs and attorney’s fees.

2. The Owner agrees to the prior approval and to pay all costs and charges for special services requested and for all veterinary fees, costs, and services incurred by the pet(s) during the stay at SHPR. The Owner acknowledges and agrees that their pet(s) shall not be delivered by SHPR to the Owner until all charges are paid to SHPR by the Owner.

3. The Owner specifically represents that he or she is the sole owner of the pet(s) and all information provided to SHPR is complete, accurate, and correct.

4. The Owner acknowledges that their pet(s) will be examined by the SHPR staff prior to acceptance of the pet(s) for admittance to ascertain any preexisting problems or conditions. If evidence of any problems or conditions is found (example – i.e. fleas), the pet(s) will be immediately treated with a topical spot-on call Advantage and receive a Capstar pill, at the Owner’s cost and expense.

Has the animal being boarded shown aggression?

Toward People

Toward Animals

Reactive with food and/or toys

Medical Consent Form (Initial one of the following choices.)

I wish to be contacted for all medical problems.

or

I wish to be contacted for only serious or life-threatening problems.

The staff of SHPR will make every reasonable attempt to contact the Owner (or the Emergency Contact) following your instructions above. If the staff is unable to reach the Owner (or the Emergency Contact), the Owner hereby authorizes SHPR to seek veterinary care for the pet(s) that is immediate, urgent, and or necessary for the well being of the animal taking into account its overall health, condition, and age. All risks with regard to the veterinary care are assumed by the Owner as well as the financial costs and expenses of the care.

Veterinary care will be provided by (Initial one of the following choices)

The staff of the Pittsfield Veterinary Hospital, Inc.

or

Staff of

We will contact the hospital and discuss your pet’s condition with their doctors. If they recommend that your pet be examined by them, there will be a $40.00 transportation fee. The Owner’s veterinary hospital will directly bill the Owner for the services provided

Does your pet(s) have any medical conditions or allergies to medications we should be aware of?

Will your pet(s) be undergoing any medical procedures during their stay?

If yes, what procedure will be done, and when?

There may be additional paperwork that must be filled out for medical procedures.

During your pet's stay at SHPR, there is a possibility for personal items from the home to be destroyed by the guest while in our care. SHPR is not responsible for damage done to, destroyed, or lost during the stay. If something is missing we will do what is within our means to find the lost item.

Do you understand the risk of leaving items with your pet?

Does your pet(s) need to be on a leash while outside in our play yard?

Does Pittsfield Veterinary Hospital/SHPR have your permission to photograph your pet during their stay and use their photo on our website and or social media pages?

Does Pittsfield Veterinary Hospital/SHPR have your permission to use your pet’s first name only on our website and or social media pages if we use their image?

EMERGENCY INFORMATION

Will someone other than the Owner be picking up the pet(s)?

If yes, please write their name authorizing them to pay for and pick up your pet(s)

Signature of the Owner or Representative

Date

What is your pet(s) name?

What's your name(s)?

What day will your pet(s) be departing and approximately what time should we expect you to reunite with our friend?

Where are you going to be?

Do you want your pet to be on a leash while out in the play yard?

Feeding Instructions

How many times per day should we feed your pet?

Medication Instructions

Other people authorized to pick-up your pet from SHPR

THE RULES

1. Please do not use this pass if your pet is partaking in other services during their stay or proof of vaccinations needed to be updated in our system. Examples: Exam, Vaccines, Surgery, and Sedation.

2. Our Hours for Drop-off and Pick-up are:

• Monday - Friday 9:00 am - 6:30 pm*

• Saturday 10:00 am - 4:00 pm

• Sunday 10:00 am - 4:00 pm

Arrangements for early Drop-off can be made prior to stay with Resort Management.
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*There will be additonal charges for picking up after 1:00 pm on weekdays*