Allentown Cat Clinic Boarding Agreement 1. Client & Patient InformationClient Name(Required) First Last Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cat's Name(Required)Breed(Required) DSH DMH DLH Pure Breed Enter Breed(Required)Color(Required)Sex(Required) Male Female Neutered/Spayed?(Required) Yes No DOB(Required) MM slash DD slash YYYY Authorized Emergency Contact (if we cannot reach you) This individual will be contacted if you are unreachable during your cat’s stay and is authorized to make medical decisions on your behalf, including decisions regarding treatment, surgery, or humane euthanasia if necessary:Name(Required) First Last Phone(Required)All cats must be in a carrier at drop-off for safety.2. Boarding Dates & Vaccination StatusAll cats must be current on their exam and rabies and distemper vaccinations. Boarding Dates From(Required) MM slash DD slash YYYY Boarding Dates To(Required) MM slash DD slash YYYY Date of Last Vaccinations(FVRCP) MM slash DD slash YYYY Date of Last Vaccinations(Rabies) MM slash DD slash YYYY 3. Pre-Boarding Medical DisclosuresHas your cat been seen by another veterinary facility in the last 12 months?(Required) Yes No If yes, please provide the name of the facility, the reason for the visit and medical records:(Required)Is your cat currently receiving any new or revised medications or treatments?(Required) Yes No If yes, please list all medications or treatments being administered and supply medical records:(Required)Has your cat experienced any illness, behavior changes, or medical events in the last 30 days?(Required) Yes No If yes, please describe the nature of the issue or event:(Required)If your cat is currently being treated from another facility or is currently exhibiting signs of illness, a pre-boarding exam is required. Failure to disclose may result in delayed or denied boarding.4. Personal Items BroughtPersonal items may be left at your own risk. We are not responsible for loss or damage.5. Dietary NeedsFood Provided Owner-supplied Clinic-provided Canned Food(Required) Yes No Canned Food Brand/Flavor(Required)Please enter brand and flavorFrequency(Required) Once a day Twice a day Three times a day Amount(Required)Please enter amount of food given.Dry Food(Required) Yes No Dry Food Brand/Flavor(Required)Please enter brand and flavor.Frequency(Required) Once a day Twice a day Three times a day Amount(Required)Please enter amount of food given.6. Flea ControlHas you cat been treated for fleas in the past month?(Required) Yes No All cats must be free of parasites. Treatment will be administered at owner’s expense if fleas are found.If yes(Required)Please write the product used and date of treatment7. Medications While BoardingAre any medications necessary to be administered while boarding?(Required) Yes No Medications must be in original veterinary-labeled containers.Medication Name(Required)Dosage(Required)Frequency(Required)Last Time Given(Required)Do you need to enter more than one medication?(Required) Yes No Medication Name(Required)Dosage(Required)Frequency(Required)Last Time Given(Required)Medication NameDosageFrequencyLast Time GivenMedication NameDosageFrequencyLast Time GivenMedication NameDosageFrequencyLast Time GivenI acknowledge that medications must be in original veterinary-label containers.Initials(Required)8. Additional Notes9. Medical Authorization & Emergency PolicyA. In-Clinic Medical Authorization I authorize Allentown Cat Clinic to provide any necessary medical care for my cat while boarding, including but not limited to diagnostics, treatment, emergency procedures, hospitalization, and surgery. If a serious medical condition arises during business hours, we will make every effort to reach you first, using the contact information provided. If you are unavailable, we will then contact your listed Authorized Emergency Contact. If no authorized individual can be reached in a timely manner, I authorize the attending veterinarian to make medical decisions in the best interest of my cat, including the performance of humane euthanasia if deemed necessary to prevent suffering. I accept full financial responsibility for all services provided while my cat is under the care of Allentown Cat Clinic. B. Emergency Hospital Authorization I understand that Allentown Cat Clinic is not staffed overnight. If a medical emergency occurs outside of regular business hours or requires intensive care beyond the clinic’s capabilities, my cat may be transported to Eastern PA Veterinary Medical Center or another qualified emergency facility. I authorize the emergency facility to administer diagnostics, treatment, hospitalization, emergency surgery, or humane euthanasia, as deemed medically necessary by the attending veterinarian. I authorize Allentown Cat Clinic staff to approve such care on my behalf if I and my Authorized Emergency Contact cannot be reached. I accept full financial responsibility for all emergency services, including transport and external facility charges. InitialsOptional Emergency Directive(Required) DNR (Do Not Resuscitate) – Allow natural death Full Code – Perform all life-saving measures In the event your cat experiences cardiac or respiratory arrest while you are unreachable10. Photo ReleaseMay we photograph your cat for social media use?(Required) Yes No 11. Boarding Terms & Policies Boarding is charged per night, regardless of drop-off time. Full payment is due at pick up. Reasonable precautions will be used to prevent injury, escape or death of this cat. You agree to hold harmless Allentown Cat Clinic and its staff for problems that develop, even when reasonable care is exercised. 12. Acknowledgment & Signature I have read, understand and agree to the Allentown Cat Clinic Boarding Agreement and all policies listed above. Client Signature(Required)Date MM slash DD slash YYYY FOR STAFF USE ONLY - Admitting Staff Initials:
