Pet Care Registration and Request Form

Based out of Weare, NH

Peaceofmindpetcarenhllc@outlook.com

www.Peaceofmindpetcarellc.nhpetsitting.com

(603) 562-8596
Pet Care Registration and Request Form

Please fill out the form below and we will get back soon to you for more updates and plan your request! This form does NOT act as a confirmation, this form allows our team to have the required information needed to plan your cares.
Name*

First NameLast Name
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Have you been a client with us before?

YesNo
Emergency Contact:*

First NameLast Name
Emergency Contact Phone Number:*
Please enter a valid phone number.
How many pets do you have?

Pet Information:

	Name	Age	Species/Breed	Spayed/Neutered?	Medications/Supplements? (Yes or No)*details below
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5

Which pet care service are you interested in?*
What is the best way to reach you while your pet is staying with us?*

PhoneTextEmailI will not be reachable, please use my emergency contact
Please list your regular veterinarian and/or preferred emergency veterinarian. In the event of an emergency, I understand my pet may need to be brought to the nearest veterinary facility if indicated. POMPC is not responsible for any associated costs due to veterinary care.*
For overnight, vacation or farm cares

Please fill out information below:

Food preparation is essential to ensure your pet sitter is able to care for your pets while you're away. Please be sure you are providing ample amount of food, any medications and supplements your pet needs. Notes are extremely helpful- Please leave one for us prior to your pet care for any details! In emergencies, POMPC can retrieve food from the store if necessary but are not responsible for the purchase price of the food. It is helpful if you can provide all dry food in individual ziploc bags labeled with your pets name, the date the food is provided for, and AM, MIDDAY or PM. If you are unable to do so, please be sure we are aware of where your pets diet is stored.
Date Range of Coverage Needed: (Ex:9/5/23-9/15/23)
Diet-Name of Food
How many times/day?
How much at each feeding?
Medications & Instructions
Please list any additional information we should know about your pet(s)!
Do we have permission to use photos of your pet(s) on our social media and website?*

YesNo
By signing below, you agree to the pricing and policies listed on our website.*

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