Dog Boarding Form

For the safety of all our patients, we require all boarders to have proof of current vaccinations. We reserve the right to turn away any boarder that is past due for vaccines:

Dogs: Distemper Adenovirus, Parvovirus, Parainfluenza, Bordetella, Cats:
Rhinotracheitis, Calicivirus, Pneumonitis, Feline Distemper and Panleukopenia

I certify that my pet(s) are current on all required vaccinations for boarding and that I have provided BPS with a copy of my pet's up to date full medical record for their file.

Please provide the following information regarding your pet's health history.

1. Does your pet suffer from any of the following conditions? (X)

2. Has your pet been treated for fleas or ticks in the past 30 days?

Yes No

3. Has your pet been dewormed in the past 3 months?

Yes No

4. Is your pet under sedation?

Yes No

5. Is your pet pregnant or nursing?

Yes No

6. Are there any other health or behavioral issues (injuries, wounds, and illness ETC...) Y N Please list any other Medical Conditions your pet has or any Special Care that your pet may need:

Yes No

f. Belongings and Bedding:

Because bedding is difficult to label and we constantly clean cages and wash blankets, we do not recommend bringing your own blankets or bedding or toys or other personal effects. Occasionally, personal belongings are mixed in with our laundry. We will do everything we can to keep track of your bedding and any other items you bring, but we cannot be responsible for the loss or damage of any personal blankets or bedding or toys or other personal effects.

My pet's belongings:

Please list below any medication(s) that your pet(s) require(s) us to administer while staying with us. We cannot be responsible for injuries, sickness or harm to pets caused by medications prescribed by other veterinarians. We will only dispense medications to pets according to your instructions below (all medications must be in their originally dispensed bottle(s)).

Last dose given (time)

h. Additional Procedures:

Are there any other procedures that you would like us to perform during your pet's stay?

Yes No

*If yes, please ask a receptionist for a "Procedures / Surgical Consent" form.

i. Payment Payment for boarding is due as follows: 50% (of the total cost of your pet's boarding) is payable as a non-refundable, non-transferrable, non-assignable boarding deposit (the "Deposit") at the BPS time of reserving your boarding space and the remaining 50% balance owed for your pet's boarding and bath (if any) is payable in full at the time your pet is delivered to BPS to start their boarding. In addition, any medical examinations, testing, treatment or other services or products used for your pet during his/her boarding stay is payable in full at the time your pet is picked up from Boarding.

A. Owner certifies to the correctness of the information given above with respect to the animal and specifically agrees to be bound by the terms and conditions BPS of this agreement.

B. Owner specifically represents that (he/she) is the owner of the animal and that there is not now any lien or other encumbrance against the animal and that the animal has not been exposed to Parvovirus, Leptospirosis or Rabies prior to admittance to the custody of BPS.

C. Facebook: We want to share your pet's adorable pictures and story with others. Do you grant BPS permission to post your pet's picture and story on social media and our website (YES) (NO)? Your personal information will not be shared.

A. BPS Limited (t/a Bermuda Veterinary Services) ("BPS") and its respective owners, employees and agents, shall not be liable for any damages to the animal arising out of or from the boarding of the animal, or that may accrue from any cause in connection with such boarding including loss by fire, theft, running away, death, or injury during the term of this agreement, whether the animal is on the premises of BPS or not, except where the loss is caused by the gross negligence of BPS, or its owners, employees or agents.

B: Owner shall be solely responsible for all of the acts of the animal at any time during the term of this agreement, and in no case shall BPS be liable for the animal's acts and behavior other than for the exercise of gross negligence on the part of BPS, its owners, employees or agents in the boarding and keeping of the animal. Owner shall indemnify BPS from and against all damages sustained or suffered by reason of the boarding of the animal for any claims or injuries arising out of the boarding of the animal except where the injury is caused by the gross negligence of BPS, or its owners, employees, or agents.

C. Owner agrees that BPS will not be held responsible for aggravation of any pre-existing medical conditions. These include, but are not limited to, heart disease, arthritis, obesity, infections, and any other conditions that might be discovered by examination.

D. Owner agrees that BPSdoes not assume and shall not be responsible for the loss and or destruction of personal belongings left with the pet while boarding, including, but not limited to, bedding, blankets, toys, dishes, collars, or leashes.

E. An animal in a group situation, such as boarding, grooming, dog park, training classes, etc., is exposed to common illnesses, like that of humans. Owner agrees to assume the risks and hazards that may be expected to arise from interaction with other animals.

Bermuda Pet Sitters

Bermuda Pet Sitters