Pet Care Holiday Consent Form

ABVC have created this Holiday consent form in order to get your consent to care for your Pet in the event something happens while you are travelling. Please read, fill out and sign before returning it to us. We will ensure your Pet receives the best care and all is done to ensure it’s safety and health.

Holiday Consent Form

This form, when filled out and signed, will entitle Al Barsha Veterinary Clinic llc and ABVC Kennels & Cattery llc, to take action in case deemed necessary to ensure safety and health of your Pet during your abscence.

* Client name

First

Last

Client ID

To be completed by ABVC Staff only

Field Label

Street Address

Address Line 2

City

State / Region / Province

ZIP / Postal Code

Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao, People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe Country

* Telephone or Mobile Phone Number

* How can we reach you when abroad

Please state if you have a different number abroad and in which time zone you will be.

* Emergency Contact

* Email Address

* Pet's Name

Patient ID

To be completed by ABVC Staff only

* Microchip Number

* Species Dog Cat Other

Weight

Pet's Location At home with Maid At home with Petsitter Friends House Boarding Facility Clinic

* Holiday Start Date

* Holiday End Date

Special Notes

Consent

I/we, owner of the pet stated above, hereby give my/our consent to the veterinarians of Al Barsha Veterinary Clinic to treat my pet if needed during my/our absence, in order to maintain and preserve quality of life

I/we prefer to be informed prior to treatment but do understand that this might not always be possible

I/we understand that if a situation arises that greatly affects quality of life, the veterinarians of Al Barsha Veterinary Clinic have my/our consent to euthanise my/our pet and to dispose of its bodily remains

I would prefer to have my/our pet euthanized in case I/we can not be reached and if the costs associated with the veterinary care exceed the amount of

*