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Boarding Admission Form

Please fill out the form below only after you have secured a boarding reservation for your pet(s) with Camp Lange. Completion of this form does not secure a boarding reservation.

Please call us at 865-690-6481 if you still need to finalize boarding dates for your pet's stay.

Owners Information

First Name

Last Name

Email

Phone number

Emergency contact person

Emergency contact phone number

Check-In date

Check-Out date

Pets Information

Pets Name

Species

Breed

Color

Age

Will your pet be having a surgical procedure or anything requiring sedation during your stay?

Yes

Medical Notes

Anything we should know about your pet prior to boarding?

Service Request by owner

Please check the services you wish for your pet to receive while at Camp Lange.

Exam Services

Adult Wellness Exam

Senior Wellness Exam

Medical Concern Exam

No Exam needed

Diagnostic Services

Fecal Test

Heartworm Test

Senior Early Detection Screening

None

Other

Grooming Services

Bath

Ear Cleaning

Nail Trim

Anal Gland Expression

Spa package (includes all of the above)

None

Playtime Services at Camp Lange

Boarding services are offered per night, at $34.60 per cat, and $55.05 per dog. Additionally, 20-minute play times can be requested. Playtime per day is $19.38 for a single pet. If you have multiple pets for playtime, the cost will $14.47 per pet, per playtime. To receive this discount, the pets must have playtimes together.

Optional add-on service: daily photo update offered Monday through Friday at $5.75 per pet. Not available on days of arrival or departure.

Please let us know what kind of play your pet prefers such as cuddle time, romp and play, etc. You can bring your pet's favorite toys or your pet can play with the toys we provide at Camp Lange. Other pets at Camp Lange will not share your pet's playtime. This ensures that your pet stay safe while playing. Please note that your pet will never be left alone during their playtimes.

We will gladly send you pictures of your pet(s) during playtimes. You only need to provide us with your cell phone number and we will send you pictures via text message.

Note: Playtimes are not available on the weekends, on the day of drop-off or pick-up, nor on the day that your pet receives a bath.

Would you like to add-on a daily photo update? (Offered Mon-Friday, at $5.75 per pet, per day)

Yes

Would you like to request a playtime, one per day, for your pet?

Yes

Cell phone number to receive playtime text message photos

What kind of playtime(s) would your pet like? Please specify activities such as cuddle time, fetch, romp and play, toys from home, etc.

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I grant Lange Animal Hospital and its representatives and employees the right to take photographs of me and/or my pet, and to copyright, use, and publish the same in print and/or electronically.

I agree that Lange Animal Hospital may use such photographs of me and/or my pet with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and web content.

By submitting, I release the use of my pet's photos to be used in social media and marketing at Lange Animal Hospital's discretion.

Vaccinations

All vaccinations must be current (including a fecal within 6 months) for boarding at Camp Lange. Any vaccinations that are not current will be administered at the time of admission.

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I acknowledge that any vaccination(s) not current will be administered at the time of admission.

Additional Services

Any additional services you would like to request?

Medication service request by owner

Please let us know your pet's medication needs while at Camp Lange.

For any medications given, we need medications to be brought in its original container / packaging with name, medication, and dosage visible.

Will your pet need medications given while at Camp Lange?

Yes

If yes, When was the medication last given?

Medication #1

Medication #1 Dosage

Medication #1 Frequency

Medication #2

Medication #2 Dosage

Medication #2 Frequency

Medication #3

Medication #3 Dosage

Medication #3 Frequency

Meal Plan request by owner

Please let us know if you will be bringing your pet's food, or if you prefer we supply food for your pet while at Camp Lange. *Exotic pets please bring your food from home

What kind of food will your pet eat while at Camp Lange?

Food from Camp Lange

Food from home

Feeding instructions

Personal Items

Please check if your pet's personal items—such as beds, blankets, toys, carriers—will be brought from home.
We'll do our best to keep them in good shape, but can't be held responsible for soiled or damaged items.

Will you be bringing personal items from home?

Yes

Authorization

I have agreed to the above services and information stated on this form. I hereby consent and authorize Lange Animal Hospital to prescribe for / or provide treatment for my pet as requested and / or in the event of an emergency or severe illness, and I cannot be reached by phone, I give permission for the doctors to stabilize my pet until I can be reached. I understand that I am financially responsible for the treatment of my pet and payment is due upon pick up of my pet from Lange Animal Hospital / Camp Lange.

Canine Respiratory Disease (“Kennel Cough”) is a multi-factorial disease. Despite having current vaccinations against Canine Influenza, Bordetella, Parainfluenza, and Adenovirus, in a boarding environment a dog may still develop Kennel Cough. Lange Animal Hospital takes every precaution to prevent infectious diseases. By choosing to board, Owner recognizes and accepts the risk that Pet may contract an infection. Owner acknowledges that payment for treatment of any disease will be responsibility of Owner. Lange Animal Hospital hereby disclaims any responsibility or liability for the health of any Pet which contracts Canine Respiratory Disease, or other infectious diseases, while boarding at Lange Animal Hospital.

CPR Authorization

If your pet is in critical condition and immediate treatment is needed, the initial stabilization period can cost $200 - $1000. This may include IV catheters, fluid, medications, x-rays, or other tests needed to assess your pet's condition. The doctor will talk to you about further treatment once your pet is more stable.

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No resuscitative efforts (DNR)

Basic CPR (Chest compressions, assisted breathing, medications) - If a CPR choice is not marked, basic CPR will be initiated. Once CPR is started, we will make reasonable efforts to contact you a responsible party. In the event you or a responsible party cannot be contacted, CPR may be discontinued if patient is not responding to efforts

Client Signature

Signature