Medical Boarding Form

Completion of this form does NOT guarantee a medical boarding reservation. Please call 847-885-3344 to confirm a boarding reservation at Golf Rose Animal Hospital.

"*" indicates required fields

Client Information

Pet Information

Drop-Off Date*
Pick-Up Date*

Would you like your pet bathed before pick-up?*

EMERGENCY INSTRUCTIONS: Please read thoroughly and initial/sign where necessary. These instructions will be followed in the event of an emergency while your pet is boarding with us.

In the event of an emergency, I give consent to*

I agree that all the above information is correct. I understand that proof of current vaccinations must be provided prior to boarding. Since it is necessary for my pet to be current on all vaccinations listed below, I consent to the administration of any vaccines which are due or cannot be verified.

Required Vaccines:


  • Rabies
  • Distemper
  • Bordetella
  • H3N2 (K9 Influenza)
  • Leptospirosis (Lepto)


  • Rabies
  • Distemper
Vaccination records information*

I would like to receive updates via text message.*

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EMERGENCY CARE AUTHORIZATION: In the event that emergency care is needed, Golf Rose medical staff needs your consent to treat your pet. Please fill in the fields below.

I, as listed above on this form, authorize the Golf Rose medical staff to treat my pet in the event of a medical emergency during boarding/hospitalization. If treatment is to exceed amount written in field below, my verbal consent will be required. I understand that any medical treatments performed will be in addition to any medical boarding/hospitalization fees. If there is an emergency, and I cannot be contacted, I authorize the following people to make medical/financial decisions in my stead.

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This field is for validation purposes and should be left unchanged.