Welcome to PacePups!
Thank you for choosing PacePups. Before we can provide services for your dog, all clients are required to complete this form in its entirety. By submitting this form, you acknowledge that the information you provide is accurate and complete, and you agree to the terms outlined in the Agreement. Completion of this form and a signed Agreement are required before any PacePups services can be scheduled or performed. If you have any questions about this Agreement or the services we provide, please contact us before submitting the form.
Client Information
Client's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Emergency Contact Name:
*
Emergency Contact Phone:
*
Relationship to Client:
*
Dog Information
Dog’s Name
*
Breed or Mix
*
Age
*
Weight
*
Sex
*
Male
Female
Spayed or Neutered
*
Yes
No
Microchipped
*
Yes
No
Veterinarian or Veterinary Clinic
*
Veterinarian Phone
*
Has your dog ever been involved in any incident involving another person or animal, or shown aggressive behavior toward humans or other dogs?
*
Yes
No
If yes, please describe the incident(s), including the date (if known), what occurred, and the outcome:
Photo and Video
*
I authorize PacePups to photograph or record my dog and use the images or recordings for social media, advertising, website content, educational content, and other promotional purposes without additional compensation.
I do not authorize PacePups to use identifiable photographs or recordings of my dog for promotional purposes.
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Continue
Continue
Should be Empty: