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Boarding Registration & Consent

Boarding Registration & Consent

For your pet’s safety and the safety of all our guests, please complete the entire form below so we are able to fully welcome your pets for their stay with us!

Boarding Registration & Consent

Name*
First Last
Email Address*
Phone*
Alternate Phone
Pet's Name*
Species*
What Species if "Other"?
Sex*
Breed*
Color*
Date of Birth*
MM slash DD slash YYYY
Weight*
Will your pet be sharing a kennel with another pet?
- Yes
- No
If yes, please list who they will be sharing with:
is your pet aggressive toward other animals?
- Yes
- No
Has your pet bitten another animal?
- Yes
- No
Is your pet aggressive towards humans?
- Yes
- No
Has your pet bitten a human?
- Yes
- No
Will you be bringing your pet's own food?
- Yes
- No
If "Yes," please package your food in individual zip lock bags for your pet's entire stay. Each bag needs to be labelled with your pet's name and time of dining for each day. Please do not bring giant food bags unless your pet is staying longer than 2 weeks.
Does your pet need to be separated from other guests to eat?
- Yes
- No
Boarding Drop-Off Date*
MM slash DD slash YYYY
Boarding PIck-Up Date*
MM slash DD slash YYYY

Please note: Your pet(s) must be picked up by 2:30 PM or you will be charged for that day.
Please list any medications/supplements/prescription diets your pet is currently taking:*
Please check any of the following symptoms you have noticed recently with your pet:*
- Vomiting
- Difficulty Breathing
- Drinking Less
- Limping
- Diarrhea
- Sneezing
- Weight Gain
- Fleas/Ticks
- Constipation
- Eating More
- Weight Loss
- Ear Discharge/Smell
- Frequent Urination
- Eating Less
- Itching/Chewing
- Eye Discharge
- Coughing
- Drinking More
- Hair Loss
- Pain/Stiffness
- Lethargy
- Bad Breath
- None
Please select any additional services you would like to have performed:
- Nail Trim
- Vaccinations
- Bath
- Express Anal Glands
- Clean Ears
- Pull Ear Hair
- Other
If you selected "Other," please describe:
If other people are authorized to pick up your pet, please list their name and phone number below:
We appreciate that you have entrusted the care of your pet to us during your absence. To ensure the safest environment for all pets being boarded/medically boarded at our hospital we have set the following guidelines:
1. Dogs must be current on rabies, distemper/parvo, Bordetella, and canine influenza vaccinations as well as a negative fecal test.
2. Cats must be current on rabies, FVRCP, and Feline Leukemia vaccines.
3. If services listed in 1 or 2 are performed by SRVC at the time of boarding, an examination fee will be charged in addition to a fee for each of the services provided.
4. Pets found with internal or external parasites will be treated at the owner’s expense. We take precautions to prevent flea problems. If fleas are found additional charges may be incurred at the owner’s expense, these services can include but not limited to a flea bath and flea medication (Capstar).
5. The hospital requests that personal belongings such as toys, blankets, and bedding NOT be left for your pet. SRVC is not responsible for them becoming lost, broken, soiled, or damaged. Thank you for your understanding.
6. Pets that become excessively soiled while boarding will be bathed, if necessary, at the client’s expense.
7. A Medication Administration fee of $4.50 for each day your pet receives medications will be charged.
Signature of Owner, Agent or Authorized Person*
Please provide your signature indicating your preference for the above selections.
Though every attempt will be made to reach, should problems arise in your absence, we will perform any necessary treatment to ensure your pet’s good health. A change in hospital status may need to occur based on the veterinarian’s medical assessment (i.e., to a higher level of medical boarding or hospitalization). This would necessitate additional costs for medical treatment and nursing care. I authorize the staff of SRVC to do whatever they deem necessary for the health and well-being of my pet(s) and agree to pay for all expenses relating to such care. This includes, but not limited, to any veterinary expense SRVC determines is reasonably necessary for any injury or illness that SRVC determines needs immediate attention.
Signature of Owner, Agent or Authorized Person*
Please provide your signature indicating your preference for the above selections.
I release SRVC of all liability should my pet’s life be lost due to unforeseen situations, including fire and natural catastrophe.
Signature of Owner, Agent or Authorized Person*
Please provide your signature indicating your preference for the above selections.
I understand that if I neglect to call or pick up my pet after five (5) days of the stated discharge date, SRVC will assume that I have abandoned my pet. I understand that SRVC will abide by standard legal steps for abandoned pets.
Signature of Owner, Agent or Authorized Person*
Please provide your signature indicating your preference for the above selections.
I understand that refills are needed for medications or prescription foods prescribed to my pet(s) while he/she is boarding at SRVC I will be responsible for charges incurred.
Signature of Owner, Agent or Authorized Person*
Please provide your signature indicating your preference for the above selections.
I acknowledge that all pet(s) must have the required vaccinations 48 hours prior to boarding reservation drop-off. Should my pet contract kennel cough or canine influenza, I agree to release SRVC from all liability, as these diseases are airborne and cannot be detected until symptoms are present.
Signature of Owner, Agent or Authorized Person*
Please provide your signature indicating your preference for the above selections.
Pets must be picked up on their last day of boarding by 2:30 p.m. or an additional charge will be incurred for that day.
Signature of Owner, Agent or Authorized Person*
Please provide your signature indicating your preference for the above selections.
I am the owner or agent of the above described animal, I am at least 18 years of age, and I have the authority to execute this consent. I understand that Shackleford Road Veterinary Clinic requires my pet to be free from internal and external parasites and up to date on all vaccinations. I am financially responsible for all medical procedures and treatments, as well as for any cost associated with vaccination or parasite treatment and that this payment is due upon discharge. I understand that during the performance of the aforementioned medical procedure(s) and treatment(s), unforeseen conditions may be revealed that necessitate an extension of the aforementioned medical procedure(s) and treatment(s) than those set forth above, which may result in a change in the estimated cost. Therefore, I hereby consent to and authorize the performance of such medical procedure(s) and treatment(s) as are necessary and desirable in the exercise of the veterinarian's professional judgement. I also authorize the use of appropriate anesthetics and other medications and I understand that hospital support personnel will be employed as deemed necessary by the veterinarian. I have been advised of the nature of the medical procedure(s) and treatment(s) and the risks involved. I realize that results cannot be guaranteed. I have read and understand this authorization and consent. I hereby consent I authorize the veterinarians and staff of Shackleford Road Veterinary Clinic to render treatment, and by signing below agree to all conditions. I certify that if I am signing as owner/agent, that I have the authority to execute this consent.
Signature of Owner, Agent or Authorized Person*
Please provide your signature indicating your preference for the above selections.
Date*
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.

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Customer Reviews

I have seen a lot of changes since I have been a client at Shackleford Veterinarian Clinic since 1996. The best change of all was when Dr. Barron started. You will not find a better veterinarian or staff!

C. Mayfield

SRVC answered all of my questions and even allowed me to come back after my appointment to update and add information to my pet's health certificate. I would highly recommend this vet to anyone. They go above and beyond expectation.

Tiffany Williams

I will forever be thankful that Dr. Barron was recommended by my neighbor! My pets have been treated at several different veterinary clinics, but no one has ever compared to Dr. Barron. The front desk staff and vet techs could not be kinder!

Ashley Hurst

Areas We Serve

West Little Rock
Chenal
Woodland’s Edge
Brodie Creek
Pleasant Valley
Sherwood
North Little Rock
Bryant
Alexander
Maumelle

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SRVC

Visit us:

11601 Kanis Rd

Little Rock, AR 72211

Email us:

Email: info@shacklefordvetclinic.com

Call us:

Phone: (501) 224-6998
Fax: (501) 225-3760

Hours:

Monday	7:30 AM - 5:30 PM
Tuesday	7:30 AM - 5:30 PM
Wednesday	7:30 AM - 5:30 PM
Thursday	7:30 AM - 5:30 PM
Friday	7:30 AM - 5:30 PM
Saturday	8:00 AM - 12:00 PM

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