Boarding Request & Agreement
****BOARDING IS C-L-O-S-E-D FOR MAY*****
1.	Pet Caretaker's Name:
2.	Best Phone:
3.	Email:
4.	Street Address
5.	City & Zip Code
6.	Emergency Contact Name & PHONE number
7.	Name & PHONE number of your current Vet
8.	Check In Date & TIME. Please note our hours: Mon: By Appointment Only, Tue - Fri: noon to 6 pm, Sat: 10 am to 4 pm, Sun: CLOSED ****BOARDING IS C-L-O-S-E-D FOR MAY*****
9.	Check Out Date & TIME. Please note our hours: Mon: By Appointment Only, Tue - Fri: noon to 6 pm, Sat: 10 am to 4 pm, Sun: CLOSED****BOARDING IS C-L-O-S-E-D FOR MAY*****
10.	Name of Pet(s)
11.	Type of Pet
12.	Age of Pet(s)
13.	Color of Pet(s)
14.	Sex of Pet Male Female Altered
15.	If you pet on medication? If so, type and dosage requirements
16.	Has your female pet been in contact with a male? Yes No N/A
17.	Please describe your pet's personality and behavior.
18.	Please indicate any special services you would like for your pet during his/her stay with Piggie Poo. Fleece: $5 per day Private In-Home Boarding: $5 per day Nail Clipping: ALWAYS FREE SPA Day (bath, nails & blow dry): $10 Bath (only): $5 Ear Cleaning: $5 Bottom Bob: $5 Full Trim & Matt Removal (depending on extent): $5 to $10 Perineal Sac Cleaning & Lubrication (boars only): $5 Ivermectin (mites - 3 treatments): $10 Advantage (lice): $10 Teeth Trimming (incisors only): $15 Dermazole (anti-fungal - 5 treatments): $25 Abscess Incision, Drainage & Flush (additional treatments may be required) $25
19.	Is there anything else we need to know about your pet?
20.	Emergency "Medical" Insurance Please note that in the event of a medical emergency, we must have your credit card information on file. Your credit card will only be charges actual costs up to the amount specified and your credit card information will be destroyed after your stay. Agree Disagree
21.	Credit Card Holder's Name
22.	Credit Card Number
23.	Expiration Date: MM/YY
24.	"Security" Code
25.	Maximum Authorized Veterinary Charges (i.e. $100)
26.	Please indicate that you have read and understand our Terms & Conditions. You can find our Terms & Conditions on our website at www.piggiepoo.org under the "services" page. Yes No
27.	Refund Policy Please note that boarding fees are not refundable. In the event your stay is cut short or you have a change of plans, those funds will be please in a credit account and can be used for future stays, services or products at the Squeek Shop. Agree Disagree
28.	In order to hold your space, payment is due in advance. Please give us as much notice as possible as we fill up fast during Summer and Holidays, including Spring Break. Yes, I'm ready to book my Pet's stay now! You will be redirected shortly)