ROOSEVELT VET
ROSY’S RESCUE
ROOSEVELT MANSION
845.279.6578 |
BOOK AN APPOINTMENT |
MEET ROOSEVELT
Meet Roosevelt Veterinary Center
SERVICES
Lifelong Services
General Wellcare
Vaccinations
Spay and Neuter Services
Dental Care
Diagnostics + Imaging
Surgery
Specialty Services
Boarding + Daycare
Pet Pharmacy
Emergency Care
BOARDING & DAY CARE
Roosevelt Mansion
PATIENT RESOURCES
Appointment Options
Important Forms
Payment Options
Pet Pharmacy Needs
Frequently Asked Questions (FAQs)
Latest Therapeutics
PUPPY & KITTEN PACKAGES
CONTACT US
MEET ROOSEVELT
Meet Roosevelt Veterinary Center
SERVICES
Lifelong Services
General Wellcare
Vaccinations
Spay and Neuter Services
Dental Care
Diagnostics + Imaging
Surgery
Specialty Services
Boarding + Daycare
Pet Pharmacy
Emergency Care
BOARDING & DAY CARE
Roosevelt Mansion
PATIENT RESOURCES
Appointment Options
Important Forms
Payment Options
Pet Pharmacy Needs
Frequently Asked Questions (FAQs)
Latest Therapeutics
PUPPY & KITTEN PACKAGES
CONTACT US
Roosevelt Mansion
Cat Boarding Application Form
Please complete the Roosevelt Mansion Cat Boarding Application as a first step in bringing your cat to board with us.
We look forward to meeting you and your cat!
Please enable JavaScript in your browser to complete this form.
OWNER / GUARDIAN INFORMATION
Owner/Guardian's Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Mobile Phone
*
Home Phone
Email
*
EMERGENCY CONTACT
*
First
Last
Please indicate whom we would contact in case of an emergency, if we could not reach you.
Emergency Contact Phone Number:
*
Relationship to you:
*
PET'S VETERINARIAN INFORMATION
Veterinarian Name (full)
*
First
Last
Name of Veterinarian's Clinic:
Please fill in full business name of veterinary clinic.
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Veterinarian's Phone Number
Please use the most direct phone contact to your veterinarian.
How did you hear about Roosevelt Mansion Pet Boarding and Day Care?
PET GUEST INFORMATION
Cat's Name:
*
Primary Breed:
*
Weight:
*
Color:
*
Age / Birth Date:
*
Check those elements that apply:
*
Male
Female
Spayed
Neutered
Unaltered (Intact)
Has your cat ever attended a boarding facility in the past?
*
Yes
No
Is your cat litter box trained?
*
Yes
No
Has your cat ever bitten another person or another animal?
*
Yes
No
If Yes, please explain the situation:
MEDICAL HISTORY
Is your cat currently taking any medications?
*
Yes
No
NOTE: IF YOU CHECKED YES, YOU WILL NEED TO FILL OUT AND SIGN A MEDICATION ADMINISTRATION FORM FOR EACH PET.
Has your cat been ill in the last 30 days?
*
Yes
No
Is your cat displaying any symptoms, such as sneezing, coughing, or upset stomach?
*
Yes
No
If yes, please explain the symptoms:
Does your cat have any previous or current injuries, physical problems or health concerns, including allergies?
*
Yes
No
If yes, please explain:
Does your cat have any physical restrictions while playing, or sensitive area on the body?
*
Yes
No
If yes, please explain:
VACCINATIONS
Please list the current expiration dates for the following vaccinations: (front desk may complete once they’ve received proof of current vaccinations).
Rabies Vaccine
Expiration date
FVRCP (Feline Viral Rhinotracheitis, Calicivirus, and Panleukopenia)
Expiration date
Is your cat currently on a flea preventative medication? (Required for all guests)
*
Yes
No
Name of preventative brand:
*
Last date preventative was administered:
*
PERSONALITY AND TEMPERAMENT
Please check all the traits that describe your cat:
*
Outgoing
Timid
Affectionate
Reserved
Independent
Feisty
Friendly
Playful
Confident
Submissive
Clingy
Gentle
Other
Please check all the traits that describe your cat's behavioral attributes:
*
Likes to scratch
Fear of noises
Meows excessively
Verbally sensitive
Separation anxiety
Low activity level
Medium activity level
High activity level
Other
PRICING: $30/night for each 24-hour period beginning at check-in time.
VERIFICATION
I, the undersigned, hereby acknowledge and agree that all the information in this application is complete and accurate to the best of my knowledge. I further attest that if I am not the sole owner or representative of the cat subject to this application that my signature is sufficient to enter into this application for and on behalf of any owner or representative.
Date
*
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Signature
*
Clear Signature
Please use your cursor to sign here.
Type name
*
First
Last
Please type name if you cannot sign.
Submit