Feeding/Diet Habits

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Exercise Habits (to run, walk, jump, frisbees, etc.):

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“Bathroom” Habits

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Medical History – Any health problems?

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Medications?

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Veterinarian Name

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Veterinarian Address

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Veterinarian Telephone

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WHO TO CONTACT IN CASE OF EMERGENCY?
(Relative - Name, Relationship, Address & Telephone)

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How did you hear about my services? (Newspaper or Referral)

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Number of days your pet will be staying   _______________________________

PLEASE FILL IN

Drop Off Date ________________________

Pick Up Date _________________________

Do you want your pet bathed before pick up:  Y / N (please circle one)

FEES

AUTHORIZATION

I authorize Carrie Ryberg (known as CR) to obtain any emergency veterinary care that may be necessary during the time spent with my pet.
I accept responsibility for any charges related to this emergency care.
I also authorize CR to utilize an alternative veterinarian in the event my regular veterinarian is unavailable. Every effort will be made to contact the owner prior to obtaining emergency care.

I agree to reimburse CR for any additional fees for providing emergency care, as well as any expenses incurred for unexpected visits, transportation, housing, food, or supplies.

CR agrees to provide the services stated in this agreement in a reliable, caring and trustworthy manner. In consideration of these services and as an express condition thereof, the client expressly waives and relinquishes any and all claims against CR except those arising from negligence of the pet sitter. CR is not responsible for damage incurred by pet escaping because of a faulty leash/collar or a collar that is not properly fitting.
Client agrees to notify CR of any concerns within 24 hours of any complaints.

Customer will be responsible for all medical expenses and damages resulting from an injury to the pet sitter or other persons by the pet. Customer agrees to indemnify and hold harmless CR in the event of a claim by any person injured by the pet.

This agreement is valid for all future visits until a new agreement is signed. CR reserves the right to terminate this agreement at any time, at its sole discretion; likewise, client may terminate this agreement at any time.

It is expressly understood that CR shall not be held responsible for any damages caused by client's pets during the period in which they are in its care. Client has advised CR of all situations, which will relieve it of liability for damage.

Fees are earned upon acceptance of pet sitting reservations. A fee of $25 will apply to all returned checks. Client is responsible for all costs of collection.

I have read the terms of this agreement and confirm the accuracy of the information provided.

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Client Signature

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Date

Carrie Ryberg Windsor Flat Coated Retrievers 923 County Route 601 Skillman, NJ  08558 (609) 610-4751 windsorfcr@patmedia.net www.windsorflatcoatedretrievers.com