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Medical Release Form

I/We, of , am/are the owner/have legal custody of the Pets, , who reside(s) with me/us at the address set forth above.

IN CASE OF AN EMERGENCY, I/WE authorize Holiday Barn Pet Resorts, in whose care the Pet(s) has been entrusted, to present such Pet(s) to an approved medical treatment center, and do consent to an X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care, to be rendered to the Pet under the Veterinarian or Veterinarian surgeon licensed to practice in any state of the United States.

This release is valid for one year from April 19, 2024.

All pet boarding establishments in Virginia are required to present to the consumer the following notice:

STATE OF VIRGINIA LAW
NOTICE

The boarding of animals is subject to Article 3.1 (S3.1-796.83:1 et seq.) of Chapter 27.4 of Title 3.1. If your
animal becomes ill or injured while in the custody of the boarding establishment, the boarding establishment shall provide the animal with emergency veterinary treatment for the illness or injury.

The consumer shall bear the reasonable and necessary cost of emergency veterinary treatment for any illness or injury occurring while the animal is in the custody of the boarding establishment. The boarding establishment shall bear the expense of veterinary treatment for any injury the animal sustains while at the boarding establishment if the injury resulted from the establishment’s failure, whether accidental or intentional, to provide the care required by S3.1 - 796.68; however, boarding establishments shall not be required to bear the cost of veterinary treatment for injuries resulting from the animal’s self-mutilation.

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Timestamp

Audit

June 17, 2020 4:10 pm EDT

Medical Release Form - Glen Allen Resort Uploaded by Customer Experience - do-not-reply@holidaybarn.com IP 71.63.85.40

June 25, 2020 9:57 am EDT

Dawn Lawyer - dlawyer@holidaybarn.com added by Customer Experience - do-not-reply@holidaybarn.com as a CC'd Recipient Ip: 71.63.85.40

June 25, 2020 3:14 pm EDT

Martha Prideaux - mprideaux@holidaybarn.com added by Customer Experience - do-not-reply@holidaybarn.com as a CC'd Recipient Ip: 71.63.85.40

June 29, 2020 9:10 am EDT

Reservation Specialist - reservation.specialist@holidaybarn.com added by Customer Experience - do-not-reply@holidaybarn.com as a CC'd Recipient Ip: 71.63.85.40

June 29, 2020 9:10 am EDT

Dan Stirling - dstirling@holidaybarn.com added by Customer Experience - do-not-reply@holidaybarn.com as a CC'd Recipient Ip: 71.63.85.40