Important Medical Emergency Information Name* First Last Cell Phone*Email* Pet InformationPet Name Feeding instructions: Be specific (how much, how often)*Medications: Be specific (How much, how often)Pet InformationPet Name Feeding instructions: Be specific (how much, how often)Medications: Be specific (How much, how often)Important Medical Emergency InformationShould medical attention be necessary, every attempt will be made to notify Owner regarding such situation. If Owner is not reachable and time is of the essence, the emergency contact person specified by Owner will be contacted. However, if the emergency contact is also unavailable, the Owner authorizes Sher Polvinale/HWAH to approve medical and/or emergency treatment (excluding euthanasia) as recommended by a veterinarian. The Owner releases Sher Polvinale/HWAH from all liabilities related to transportation, treatment and expense.*Please Initial aboveIn the event of a health emergency, please name your emergency contact person for this reservation that should be called to pick up your pet.* First Last Emergency Contact Cell Phone*In the case of a medical emergency, do you want your pet to be held at the Vet and on life support until your return?* Yes No Do you want your pet to be euthanized if he/she is suffering?* Yes No In the event of your pet's death, do you want he/she to be cremated and ashes returned?* Yes No In the event of your pet's death, do you want a pawprint done if available?* Yes No Additional comments you want us to know.I have reviewed this agreement in its entirety. I understand that HWAH is not responsible for unexpected circumstances beyond their control which may cause a change in their ability to provide short term stay care for my pet. I have made the appropriate choices. The information provided by me is complete and accurate and I agree to all its terms and conditions as set out above. Please put your name and date below.* First Last Date MM slash DD slash YYYY Date format: MM/DD/YYYY Δ
