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Blue Ribbon Pets

General and Medical Release
Admission Policies
Effective July 2010

 

Pet Owner Name _____________________________________ Ph ________________________

Spouse _____________________________________________ Ph ________________________

Physical Address ______________________________________ Ph _______________________

Mailing Address _______________________________________ Ph _______________________  

Email Address ________________________________________ Ph ________________________

 

Emergency Contact (not yourself, not your veterinarian, but someone we or your vet can call in case of emergency or other nessessary care that can authorize such care for your pet if we cannot locate you)
_____________________________________________ Ph ________________________

_____________________________________________ Ph ________________________

My pet(s) veterinarian is _____________________________________________________

 

Emergency Care:

Finances:

Additional Fees and Charges:

Abandoned Animals:

Signature____________________________________________  Date____________________

Vaccinations and Medical Care:

General Health and Welfare:

Group Play:

My pet is allowed group play   YES ________________      NO ________________

Fee Schedules:

 

Signature __________________________________________________   Date_______________