Senior Pet Form - Canine Country Club

Here at Canine Country Club we do everything we can to make the boarding experience as comfortable and safe as possible for our elderly guests. Despite our best efforts, being away from home may cause existing conditions to worsen or underlying conditions to become apparent.

Date

Pet Owner's Name

First Last

Mobile Phone Number

Email

Senior Pet's Name

Breed

Age

Veterinary Clinic

Please check all of the below observations that apply to your pet. Please detail the checked conditions in the space below or add anything that was not listed.

Notes or Issues not mentioned above:

We will ALWAYS try to get in touch with you immediately in an emergency.

In the event that my pet becomes ill while myself and any emergency contacts I have listed are unreachable, I give my permission to:

Take all possible measures stabilize, regardless of cost*
Do minimal to stabilize

*Regardless of cost means that, in a life threatening emergency, all medical and life preserving options will be pursued.

In the event of death:

Hold at veterinarian until I return
Individual cremation at veterinarian (retain ashes)
Non-individual cremation at veterinarian (do not retain ashes)

Pet Owner Signature*

First Last

Date