BLOSSOM’S GROOMING SALON
BOARDING ADMISSION FORM

PET(S) NAME____________________________________________________________________
IN DATE__________________________________ OUT DATE______________________________

NAME AND NUMBER OF AN EMERGENCY CONTACT: __________________________________________________________________________
MEDICAL CONDITIONS:______________________________________________________
MEDICATIONS:_____________________________________________________________
ITEMS WITH PET:___________________________________________________________

BEFORE GOING HOME:      BATH:  YES        NO              GROOM:   YES          NO

EMERGENCY CARE
I AUTHORIZE (YOUR VET) ______________________________________ TO PERFORM TREATMENT IN CASE OF ILLNESS OR AN EMERGENCY IF I OR EMERGENCY CONTACT CAN NOT BE REACHED. I CERTIFY THAT I AM THE OWNER AND OR RESPONSIBLE FOR THE PET(S) LISTED ON THIS AGREEMENT. I AGREE TO PAY FOR ALL SERVICES RENDERED, IN CLUDING ALL MEDICAL BILLS AND MEDICATIONS.
____ I HAVE RECIVED A COPY OF BLOSSOM’S GROOMING SALON BAORDING RULES AND REGULATIONS.
____I HAVE READ A THE BLOSSOM’S GROOMING SALON BOARDING RULES AND REGULATIONS.

OWNERS SIGNATURE__________________________________________DATE________________________