Name *

First

Last

Email *

Phone *

I consent to receive SMS text messages from Goodrich Veterinary Clinic. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

Check-In Date *

Check-Out Date *

Pet's Name *

Emergency Contact *

First

Last

Emergency Contact Phone *

If a critical/life threatening problem develops and we can't reach you, may we treat your pet(s)? *

Yes
No

I authorize any amount necessary for the treatment of my pet at GBVC.
I authorize a maximum amount to be used towards my pet's care at GBVC.

Please specify the maximum $ amount to be used toward your pet's care. *

Please list feeding instructions. *

When is your pet due for their next meal? *

Did you bring food for your pets? *

Yes
No

If you have not provided food, your pet will be fed Science Diet Adult pet food while boarding.

Please list any medications that your pets need while boarding, along with instructions.

Are you leaving any of the following?

Collar/Leash
Carrier
Bedding
Other

Please explain. *

Please list any procedures you would like performed during your pets' stay: (e.g. nail trim)

I, acting as owner or agent of the pet named above, hereby request and authorize Goodrich Veterinary Clinic to board the animal described above. By signing this release, I acknowledge and agree to the following terms and conditions:

Right to Refuse Service: I understand Goodrich Veterinary Clinic has the right to refuse service to any animal whom they deem as a health and/or behavior risk.
Medical Examination and Vaccinations: I understand that Goodrich Veterinary Clinic will not perform a complete physical examination nor administer vaccinations before boarding.
Vaccine Risks and Efficacy: I acknowledge that failing to keep my pet’s vaccinations up to date puts my pet at risk for disease, including but not limited to: rabies, distemper, parvo/panleukopenia virus, canine influenza, and kennel cough/respiratory disease. I understand the limitations of vaccine efficacy and waive all claims arising from the administration of any vaccines by Goodrich Veterinary Clinic.
Certification of Vaccination: I certify that my animal is current on their rabies, distemper/parvo (DHAPPV), Bordetella (kennel cough), and Canine Influenza (CIV H3N2/H3N8) vaccines, and that they are in good health. I have provided Goodrich Veterinary staff with all necessary information for my animals stay.
Dietary Requirements: I understand that if I do not provide Goodrich Veterinary with my pet’s regular diet that my pet will be given “in house” food at an additional fee.
Medications and Supplements: Medications (except controlled medications), supplements, and/or other items will be administered for an additional fee as directed, provided they are presented in their original containers with instructions for administration. I certify that I have confirmed the amount of medication(s) with Goodrich Veterinary staff.
Controlled Medications: I understand that Goodrich Veterinary will not accept nor administer any controlled medications (ex: codeine, phenobarbital, etc.) due to state and federal regulations.
Payment: Payment is due in full at the time of check-in. Any additional services provided during boarding stay must be paid in full at the time of checkout.
Liability for Personal Items: Goodrich Veterinary Clinic is not responsible for any lost or damaged personal items brought in for boarding. Any items left behind will be donated to a local shelter.

Provision of Blankets *

I hereby give permission for Goodrich Veterinary to provide my pet with blanket(s) during their boarding stay.
I DO NOT give my permission for Goodrich Veterinary to provide my pet with blanket(s) during their boarding stay.

Emergency Treatment Authorization *

I hereby grant Goodrich Veterinary Clinic permission to treat any minor illness or injury and/or to stabilize in the event of an emergency until owner or authorized person can be contacted. Any cost incurred due to the treatment will be owner’s responsibility.

Transport to Emergency Clinic *

I hereby grant Goodrich Veterinary permission to transport my pet to the nearest emergency clinic in the event they are unable to treat a medical condition that arises.
I DO NOT give Goodrich Veterinary permission to transport my pet to the nearest emergency clinic.

I approve Goodrich Veterinary to approve (insert $ amount below) in emergency treatment costs. *

Liability Disclaimer: I understand that Goodrich Veterinary is not responsible for any issue and/or injuries from your pet’s stay to include, but not limited to, cuts, scrapes, dental issues, etc.

Abandonment Policy: I understand that if I don’t retrieve my pet within seven (7) days of the agreed pickup time, Goodrich Veterinary will follow Nebraska State Laws of pet abandonment and turn my pet over to the Nebraska Humane Society. Late pickup fees and all fees with being impounded by the Nebraska Humane Society will be owner’s responsibility.

Release of Liability: By signing this release, I hereby release Goodrich Veterinary Clinic, all veterinarians, assistants, managers, and employees from any and all claims arising out of or connected with the boarding and medical treatment of my pet. I agree that I have not and will not claim any right of compensation from them, or any of them, or file action. Owner/agent hereby agrees to indemnify and hold Goodrich Veterinary Clinic harmless for any damages caused during the transportation of the animal, or for any damages caused by any unforeseeable events including dog attack/fight, fire, vandalism, burglary, extreme weather, natural disaster or acts of God.

Signature *

Clear Signature

NOTICE: Personnel are not on the premises at night and other times when the Goodrich Veterinary Clinic is not open for business. *

I have read and understand.

Boarding Form

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