Dog Walking Client Information & Consent

Dog Walking Client Information & Consent

Walking with Sarah
Walking with Sarah

Sarah Bellenie
Client's Name

First NameLast Name
Client's Email
example@example.com
Phone Number
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
If you reside in an apartment/condo building, please advise if there are any special check-in procedures
Emergency Contact Information

Pet Information
Please provide information regarding your pet(s) to be walked
I understand and agree that Walking with Sarah has relied upon my representation that my dog(s) is/are in good health and have not harmed or shown aggressive or threatening behavior towards any person or any other dog.

YesNo
Please provide further information regarding your pets (allergies, behavior, habits, etc.)
Is your dog(s) licensed and/or registered in accordance with all municipal bylaws.

YesNo
The client understands that although Walking with Sarah carefully screens all applicants, occasionally Walking with Sarah discovers that this is not an appropriate service for everydog. Walking with Sarah reserves the right to permanently remove a dog from our services at any time.

YesNo

Veterinary Information
Veterinarian Name
Vet / Clinic Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vet's Name

First NameLast Name
Vet's Phone Number
Please enter a valid phone number.
Is/Are your dog(s) current on all vaccinations including rabies and DHPP (Distemper, Hepatitis, Parainfluenza, Parvovirus)

YesNo
DHPP Date:
Rabies Date:
While my dog(s) is/are in the care and custody of Walking with Sarah, if I am unreachable in the event of an emergency, I hereby authorize Walking with Sarah, its agents, and/or representatives to seek immediate veterinary care for my dog. I agree to be financially responsible for any and all costs in connection with, veterinary, medical o rother treatment.

Yes, I agreeNo, do not seek immediate care

AGREEMENT TO HOLD HARMLESS, WAIVER AND ASSUMPTION OF RISK

I retain all liability with respect to damages and injuries to people and/or property caused by my dog(s) and am liable for damages resulting from a bite or attack by my dog on another person or animal and am solely liable for any offences contained in the Ontario Dog Owner’s Liability Act, R.S.O. 1990, Chapter D.16, and any municipal bylaws including licensing of my pet.

I hereby waive and release Walking with Sarah, its employees, member and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while walking my dog.

In consideration of and as inducement to the acceptance of my application for dog walking by Walking with Sarah, I hereby agree to indemnify and hold harmless Walking with Sarah, its employees, members and agents from any and all claims, or claims by any member of any family or any other person while walking my dog, as a result of any action by any dog, including my own.
Signature

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