Pet Respite Care Request
Contact Information
Your Name/Dog Owner of Record
First Name
Last Name
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Respite Care Information
Start Date Requested
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Do you have a specific end date in mind, or an approximate time frame for when you’d be ready to have your pet returned? This helps us plan and ensure we can provide the best care for your pet during this time.
Please tell us why you need our assistance. (i.e. hospital stay, injury, etc.)
We are happy to offer support by providing a temporary home for your pet while you focus on your needs. To ensure we can assist in the best way, we kindly ask that you share a plan for when you expect to be able to reunite with your pet. Please note that our ability to help depends on the availability of volunteers, so we may not be able to take all pets. We want to work with you to create a smooth and supportive plan for your pet during this time. If you will support when your pet comes home, please tell us your needs.
Your Dog's Details
Your Dog(s)
*
Health Details
Any medical conditions or recent injuries or illnesses?
Up to date with all vaccinations?
Yes
No
Please provide vaccination card. If unable to upload, let us know in notes.
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Any drug allergies or food sensitivities?
Feeding Instructions
Allowed treats?
Yes
No
Any additional notes about your dogs (aggressive tendencies, possessions, level of obedience and etc.) If your dog is not good with specific size pets, unaltered pets, specific genders, list that information here. If there is anything your dog is not allowed to do, please let us know.
Will your dog need any services while in our care? Nail trim, bath, grooming, specific exercise, etc?
Please list any medications here.
In case of emergency, may we take your dog to the nearest vet? Do we need to contact you and get approval for any emergency care your dog may need? Please specify how you want us to handle an emergency.
If I, the dog owner, or my emergency contact cannot be reached, the owner gives The Dog Stays and it's principals permission to make emergency decisions, along with advice from a veterinarian, for the pet that is in the best interest of the animal. I also give The Dog Stays permission to contact my veterinarian for vaccine information and any other information needed to assure my pet’s well being.
Please Select
I agree
I do no agree
I also understand and agree that in caring for my dog(s), The Dog Stays has relied on my representation that my dog(s) is/are in good health and have not been ill with a communicable condition within the last 14 days, and have not harmed or shown aggressive or threatening behavior towards any person or any other dog.
Please Select
I agree
I do not agree
I, the undersigned, HEREBY CONSENT my pet(s) to be photographed and I AUTHORIZE The Dog Stays, its employees, agents, or authorized representatives to use, reproduce, publish, transmit, distribute and display the said photograph(s) in any advertisement, Web site or other material for promotional purposes. Images are the property of The Dog Stays. The use of all images remainsroyalty free indefinitely on a voluntary basis and is not work for hire.
Please Select
I agree
I do not agree
The Dog Stays is a proud nonprofit 501(c)(3) organization dedicated to supporting individuals during their time of need. We proudly offer our services and supplies free of charge. Our mission is to advocate passionately for and provide the essential resources, education, and services necessary to keep beloved pets in their homes. Rest assured, when your pet is in our care, they will receive the same exceptional treatment as our own family pets, including a GPS monitor for outdoor activities. Our dedicated caregivers will monitor your pet closely at all times while they are outside. While we take extensive precautions, we understand that dogs can be unpredictable, and we cannot foresee every possible situation. By choosing The Dog Stays (TDS), the pet owner acknowledges and agrees to hold harmless TDS from any liability for claims or damages arising from our care, except in cases of gross negligence or intentional misconduct by TDS. Furthermore, the owner will indemnify TDS against any actions or claims from third parties that arise due to their pet on TDS property.
Please Select
I agree to the hold harmless agreement statement.
I do not agree and do not wish to have TDS provide respite care for my pet.
Is there anything else we can help with?
Vet Details
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Your Signature
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