Boarding Intake/ Emergency Contact Form

Boarding Intake/ Emergency Contact Form

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Owner Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
While I am out of town, I prefer to be contacted by
What dates will you need care?
Pet Information

Tell us about your pet(s)
Pet 1: name, age, species, and breed
Pet 2: name, age, species, and breed
Pet 3: name, age, species, and breed
Care Needs
Does your dog have any medical problems (seizures, painful conditions, etc.)?
If yes, please list them and explain any accommodations or support I should provide them.
Is your pet on any medications that we will need to administer?
If yes, please provide the medication(s), dose, and when and how to administer
What is your pet's feeding schedule, and routine? (please include food type, quantity and any additional instructions)
Please list any food restriction or known allergies
Where does your pet sleep?
Is your pet crate trained?
Where does your pet stay when you are not at home?
Please describe your pet's exercise needs
Does your pet have any of the following behavior concerns (check all that apply)

Other
Please describe in more detail the behaviors you selected above, and how you manage them
Any other behavioral quirks or concerns we should be aware of?
Describe a typical 24 hour day for your pet(s)?
Emergency Contacts and Vet Information

In the unlikely event of an emergency, we will need this information to be correct and up to date.
What should I do the event of an emergency requiring veterinary care? (see emergency policy below for more information)
What is the best phone number to reach you at, in case of an emergency?
Please enter a valid phone number.Format: (000) 000-0000.
What is the name of your primary Vet or Vet Clinic?
Primary Veterinarian's Address
Please enter a valid phone number.Format: (000) 000-0000.
Primary Veterinarian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Policies Acknowledgments
By enrolling the above named and described dog(s), Client represents that they are the legal owner of the named dog(s) and Client assumes all risks, dangers and responsibility for injuries to the named dog(s). Client understands and agrees that Client is solely responsible for any harm to Client's dog(s) while Client's dog(s) is/are under the directed care of Close to Home Pet Sitting. Client agrees that neither Close to Home Pet Sitting nor its staff will be held liable for any illness, injury, or death or Client's dog provided that reasonable care and precautions are followed. The Client releases Close to Home Pet Sitting Services LLC from all liability arising from or as a result of Client's dog(s) participating in any pet care services offered.
Client attests their dog is up to date on all vaccinations and has not have any communicable illnesses in the within 30 days of enrollment. Client understands that even if their dog is vaccinated for Bordatella (Kennel Cough) there is a chance that the dog can still contract Kennel Cough. Client agrees that Close to Home Pet Sitting Serives LLC will NOT be held responsible should Client's dog contract Kennel Cough.
Client further understands and agrees that any behavioral or physical health problems that develop with the Client's dog(s) while under the care of Close to Home Pet Sitting will be handled and treated as deemed best by the employees and staff in their sole discretion, and Client expressly agrees to assume full financial responsibility for any and all expenses arising or relating thereto.
In the event of illness or injury, Close to Home Pet Sitting will make its best efforts to contact the Client. Should emergency services be deemed necessary for the Client's dog the Client accepts veterinary charges up to the amount indicated below:
Client understands all dogs must pass a general behavioral assessment in order to attend daycare or be boarded overnight. Close to Home Pet Sitting reserves the right of refusal to any dog who shows any aggressive behavior or in anyway indicates being a danger to Close to Home Pet Care staff or other animals.
Payment Policy: For new clients, payment in full is due upon booking. We accept cash, checks, Zelle (8643535488), Venmo (@JenniferMathis24) or payment through our secure portal. Cancellation Policy: We appreciate cancellation notice as far in advance as possible. To avoid being charged, a 5 day notice is required. Cancellations within the 5 day window result in the loss of your 25% deposit. Exceptions will be addressed on a case by case basis. By checking the box below, I agree to and accept the above policies.
By typing my name below Client understands they are effectively providing their signature and hereby affirms that all above answers are correct to the best of their ability and that they have notified Close to Home Pet Sitting Services LLC of any additional information that is pertinent to the health and safety of Client's dog, Close to Home, and any/or other persons or animals with whom the Client's dog may come into contact.
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Boarding Intake/ Emergency Contact Form

Owner Information

Pet Information

Care Needs

Emergency Contacts and Vet Information

Policies Acknowledgments