Please choose your Animal Care Clinic location:

Geneva
Algonquin
South Elgin
Hoffman Estates (Barrington Square Animal Hospital)

Name*

First

Last

Email*

Address

Street Address

Address Line 2

City

State

ZIP Code

Home Phone*

Cell Phone*

Work Phone

Desired Check-In Date*

Desired Check-Out Date*

Pet Name*

Pet Gender*

Male
Female

Spayed/Neutered?*

Yes
No

Pet Breed*

Pet Color*

Pet Birthday or Approximate Age*

Is Your Pet on Medication?

Yes
No

Nail Trim

Yes
No

Groom

Yes
No

Person(s) to Contact In Case of Emergency

First

Last

Emergency Phone

We ask that you please bring in prepackaged food for your pet. Below, please include any special instructions you may have regarding their food or feeding in general.

Did We Eat This Morning?*

Yes
No

Did We Eat Dinner?*

Yes
No

MEDICAL ILLNESS POLICY – If your pet becomes ill, we will call the emergency number(s) listed above. If no one can be reached however, please indicate your wishes below should your pet require treatment.

I have read and understand.

Please perform whatever services the Doctor deems necessary until someone can be reached. I authorize medical care for my pet up to the amount indicated:

Basic Medical Treatment will be administered if deemed necessary without phone notification (A Maximum Charge of $25.00) *

I have read and understand.

Boarding Playtime Option

I approve playtime (15 minute session, charges apply)
I decline playtime

Amount of playtime sessions (15 minute session, charges apply)?

By choosing to have my dogs boarded together, I hereby release Animal Care Clinic from all liability if my dogs should cause harm/injury to each other or themselves while boarding. In addition, I understand that I am responsible for all charges incurred should medical attention due to injury be required, regardless of my Medical Illness Policy wishes as indicated earlier on this form. If you choose to have your pets boarded together, please be aware that your pets WILL NOT BE SEPARATED FOR FEEDING*

I have read and understand.

I understand that Animal Care Clinic is not responsible for lost or damaged items that I choose to leave (i.e., toys, leashes, collars, etc.)*

I have read and understand.

I HAVE READ AND UNDERSTAND THIS AGREEMENT. I FULLY INTEND TO PICK UP MY PET(S) ON THE ABOVE SPECIFIED DATE. IF CIRCUMSTANCES CHANGE, I WILL NOTIFY ANIMAL CARE CLINIC IMMEDIATELY. IN ADDITION, I UNDERSTAND THAT PAYMENT IN FULL FOR ALL SERVICES PROVIDED WILL BE DUE/PAYABLE AT THE TIME I (OR AUTHORIZED AGENT) PICK UP MY PET(S). I UNDERSTAND THAT IF I DO NOT PICK MY PET UP ON THE DESIGNATED DATE, I WILL BE CHARGED ADDITIONAL NIGHTS FOR BOARDING.*

I have read and understand.

Today's Date*

I grant Animal Care Clinic, its representatives and employees the permission to take photographs of my pet(s). I understand that the images may be used in print publications, online publications, presentations, websites, and social media.*

I have read and understand.

IF ARRANGING FOR A FRIEND OR FAMILY MEMBER TO PICK UP YOUR PET, PLEASE PROVIDE US WITH THEIR NAME AND PHONE NUMBER. ID IS REQUIRED AT PICK UP.

Canine Boarding Form

Canine Boarding Form

Get in touch

847-742-5700

Business Hours

847-742-5700