Drop In Pet Sitting Intake and Emergency Contact Form Template
Owner Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
While I am out of town, I prefer to be contacted by
Please Select
Phone Call
Text
Email
What dates will you need me?
Pet Information
Tell me about your animal(s)
Pet 1: name, age, species, and breed
*
Pet 2: name, age, species, and breed
Pet 3: name, age, species, and breed
Pet 4: name, age, species, and breed
Pet 5: name, age, species, and breed
Care Needs
Does your animal have any medical problems (seizures, painful conditions, etc.)?
*
Yes
No
If yes, please list them and explain any accommodations or support I should provide them.
Is your pet on any medications that I will need to administer?
*
Yes
No
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?
*
Where does your pet stay when you are not at home?
*
If your pet needs to be crated or confined, how do they react?
*
Please describe your pet's exercise needs
*
Does your pert have any of the following behavior concerns (check all that apply)
*
Fear or reactivity to strangers
Fear or reactivity to animals (outside or on leash)
Resource guarding or aggression around food, places, or objects
Escape behaviors (from confinement, or property)
Other
Please describe in more detain the behaviors you selected above, and how you manage them
Any other behavioral quirks or concerns I should be aware of?
Describe a typical 24 hour day for your pet(s)?
Are there any other tasks you need me to do (ie. watering plants, putting out trash bins)
Emergency Contacts and Vet Information
In the unlikely event of an emergency, I will use 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)
*
Contact me first
Seek immediate veterinary attention
Contact my secondary contact first
What is the best phone number to reach you at, in case of an emergency?
*
Please enter a valid phone number.
What is the name of your primary Vet or Vet Clinic?
*
What is the phone number of your Vet or Vet Clinic?
*
Please enter a valid phone number.
Does your primary veterinarian have 24h emergency hours?
*
Yes
No
If No, please list the name, and number of your preferred 24-hour Emergency vet
Secondary Contact: In the event that you cannot be reached, Is there someone I can contact for additional support?
*
First Name
Last Name
Secondary Contact Phone Number
*
Please enter a valid phone number.
Relationship to you
*
Vaccination Record Upload
Browse Files
Drag and drop files here
Choose a file
Please upload a current copy of your pet's vaccination records as applicable.
Cancel
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Policies Acknowledgments
Beth Booher will endeavor to create as safe an environment as possible for the care of my animal(s) and will offer only a sound, safe, and responsible environment. However, I recognize that Beth Booher is not responsible for any unintentional errors, omissions, or incorrect assertions. I understand that the recommendation of any other product or service is not a guarantee of my satisfaction with that product or service. Further, I am and will remain responsible for the actions of my animal(s) at all times and I hereby agree to indemnify and hold harmless Beth Booher of any and all claims of injury, expense, costs, or damages caused by the actions of my animal(s) while under Beth Booher's care, or control. I have been told by Beth Booher and understand the inherent risks of owning an animal(s) , including but not limited to the risk of animal bites to myself or others. Emergency Care: In the event that I cannot be reached, Beth Booher has my permission to react to a situation as she deems appropriate, and or necessary for the health and safety of my animal(s), herself, or others, and that I am responsible for compensating Beth Booher for any monetary charges made for items and or services including but not limited to, vet bills, pet food, or human medical attention. Payment Policy: A 25% deposit is due upon booking, the remainder of the payment for services is due upon completion of pet sitting, before pick up. I accept cash, PayPal, or Venmo. Cancellation Policy: We appreciate cancellation notice as far in advance as possible. To avoid being charged, a 72-hour (3 day) notice is required. Cancellations within the 72-hour 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.
*
I agree and acknowledge
Submit
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