Lisa`s Pet Care Services - Registration Form (New Client)

Lisa’s Pet Care Services - Registration Form (New Client)
CLIENT INFORMATION
Client Name _______________________________________________________________
Home Phone ___________________________ Alternate Phone _________________________
Email(s) __________________________________________________________________________________________
Address __________________________________________________________________________________________
City ____________________________________________ State ____________ Zip _____________________________
How did you find me?  Yelp  Angie’s List  PSI (Pet Sitters International) Website  NAPPS Website  Internet Search
 Pet Sitters Associates, LLC Website  Other: _______________________  Referred by: _____________________________
Local Emergency Contact (Friend / Family Member)
Name ___________________________________________________ Phone ___________________________________
Preferred Animal Hospital & Veterinarian
\
Animal Hospital ___________________________________________________________________________________
Address __________________________________________________________________________________________
Phone ________________________________________ Preferred Veterinarian________________________________
PET INFORMATION
PET - A
Pet Name ________________________________________ Species:  Dog
 Cat
 Other: ______________
Breed(s) /Type(s): ___________________________________________________ Age: ___________________________
Color/Special Markings: ______________________________________________________________________________
Sex & Reproductive System:
 Male  Neutered
/
 Female  Spayed
Are recommended vaccines current, including the Rabies Vaccine, for this pet?  Yes  No
FEEDING INSTRUCTIONS: (Be specific with type/brand, amounts, times, etc.) Use  TAP  FILTERED  BOTTLED Water
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
MEDICATIONS / SUPPLEMENTS: (Be specific with type/name, amounts, time given, how it is administered, etc.)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
 No medications or supplements to be given during visits for this pet.
Lisa’s Pet Care Services / (702) 292-4950 / EmrichLisa@cs.com / www.LisasPetCareServices.com
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HEALTH HISTORY:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Other Special Care Needs: ___________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Any recent health issues, behavioral changes or anything else I should be aware of?
(e.g., “She sometimes holds up her right back leg for a few seconds when she walks but it is nothing to worry about.” or “He broke into a bag of trail mix the night
before we left for our trip so watch him for a few days to make sure he is okay.”)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
PET - B
Pet Name ________________________________________ Species:  Dog
 Cat
 Other: ______________
Breed(s) /Type(s): ___________________________________________________ Age: ___________________________
Color/Special Markings: ______________________________________________________________________________
Sex & Reproductive System:
 Male  Neutered
/
 Female  Spayed
Are recommended vaccines current, including the Rabies Vaccine, for this pet?  Yes  No
FEEDING INSTRUCTIONS: (Be specific with type/brand, amounts, times, etc.) Use  TAP  FILTERED  BOTTLED Water
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
MEDICATIONS / SUPPLEMENTS: (Be specific with type/name, amounts, time given, how it is administered, etc.)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
 No medications or supplements to be given during visits for this pet.
HEALTH HISTORY:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Lisa’s Pet Care Services / (702) 292-4950 / EmrichLisa@cs.com / www.LisasPetCareServices.com
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Other Special Care Needs: ___________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Any recent health issues, behavioral changes or anything else I should be aware of?
(e.g., “She sometimes holds up her right back leg for a few seconds when she walks but it is nothing to worry about.” or “He broke into a bag of trail mix the night
before we left for our trip so watch him for a few days to make sure he is okay.”)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
PET - C
Pet Name ________________________________________ Species:  Dog
 Cat
 Other: ______________
Breed(s) /Type(s): ___________________________________________________ Age: ___________________________
Color/Special Markings: ______________________________________________________________________________
Sex & Reproductive System:
 Male  Neutered
/
 Female  Spayed
Are recommended vaccines current, including the Rabies Vaccine, for this pet?  Yes  No
FEEDING INSTRUCTIONS: (Be specific with type/brand, amounts, times, etc.) Use  TAP  FILTERED  BOTTLED Water
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
MEDICATIONS / SUPPLEMENTS: (Be specific with type/name, amounts, time given, how it is administered, etc.)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
 No medications or supplements to be given during visits for this pet.
HEALTH HISTORY:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Other Special Care Needs: ___________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Lisa’s Pet Care Services / (702) 292-4950 / EmrichLisa@cs.com / www.LisasPetCareServices.com
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Any recent health issues, behavioral changes or anything else I should be aware of?
(e.g., “She sometimes holds up her right back leg for a few seconds when she walks but it is nothing to worry about.” or “He broke into a bag of trail mix the night
before we left for our trip so watch him for a few days to make sure he is okay.”)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
PET - D
Pet Name ________________________________________ Species:  Dog
 Cat
 Other: ______________
Breed(s) /Type(s): ___________________________________________________ Age: ___________________________
Color/Special Markings: ______________________________________________________________________________
Sex & Reproductive System:
 Male  Neutered
/
 Female  Spayed
Are recommended vaccines current, including the Rabies Vaccine, for this pet?  Yes  No
FEEDING INSTRUCTIONS: (Be specific with type/brand, amounts, times, etc.) Use  TAP  FILTERED  BOTTLED Water
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
MEDICATIONS / SUPPLEMENTS: (Be specific with type/name, amounts, time given, how it is administered, etc.)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
 No medications or supplements to be given during visits for this pet.
HEALTH HISTORY:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Other Special Care Needs: ___________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Any recent health issues, behavioral changes or anything else I should be aware of?
(e.g., “She sometimes holds up her right back leg for a few seconds when she walks but it is nothing to worry about.” or “He broke into a bag of trail mix the night
before we left for our trip so watch him for a few days to make sure he is okay.”)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Lisa’s Pet Care Services / (702) 292-4950 / EmrichLisa@cs.com / www.LisasPetCareServices.com
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CONTINUE HERE FOR ALL PETS
WALKING / POTTY BREAK SCHEDULE (if applicable)
Use doggie door at home?  Yes  No
Need to be let out into backyard?  Yes  No If yes, # of times per day? ________
Take daily walks?  Yes  No If yes, provide requested schedule and amount of time your dog (s) are accustom to walking.
If more than one dog in the home, do all dogs go for walks and do they walk together?  Yes  No
(Provide instruction including where collars/leashes are located & which one belongs to which dog if not obvious)
If more than one pet in the home, how do the pets interact with each other?
Let me know if there are any situations I should avoid (e.g., feeding near each other, etc.)
Describe some favorite play time activities (e.g., special toys, fetch game, etc.)
Please provide any other information that you feel would be helpful to know about your pet(s) to assist in providing the
best care:
SPECIAL PET & HOME INSTRUCTIONS
 Yes  No -> Pick-up Mail from Mailbox # __________ ? (please leave key)
 Yes  No -> Water Indoor / Outdoor Plants? (please describe location)
 Yes  No -> Will anyone be entering home / property during my visits (e.g., housecleaner, gardener, pool
cleaner, etc. – please provide information) ?
 Yes  No -> Keep door from house to garage locked ?
 Mon  Tue  Wed  Thu  Fri  Sat -> Trash Days ?
OTHER
Lisa’s Pet Care Services / (702) 292-4950 / EmrichLisa@cs.com / www.LisasPetCareServices.com
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VISIT UPDATE PREFERENCE
[Regardless of preference, a “Visit Log” will be maintained and left for client at last visit. If client uses PetWatchman, the “Visit Log”
will be maintained electronically. Additional update preferences should be noted below.]
I prefer to be updated / contacted:  After each visit  Once daily  Every 2-3 days  Only if issue/concern
VIA:  Text  Email or  Phone and  PetWatchman (FREE Mobile App – Client must download from home location for GPS
locator to work correctly and client must register 5 days prior to first visit at: www.PetWatchman.com or via App Store on SmartPhones.)
COMMUNITY & HOME ACCESS
Community Access:  Guard Gated (Name will be left with Security)  Gate Code: _______________  Open
Home Access:  Key(s)  Garage Door Opener  Garage Door Key Pad Code: _____________________________
 Alarm Code to be provided If ALARM CODE is to be provided, please call with code.
For Overnight Stays Only – The Wi-Fi Passcode would be appreciated: ________________________________________
Where will key or garage door opener be left (if not already provided)? _______________________________________
_________________________________________________________________________________________________
Request key / garage door opener be picked up prior to first visit?  Yes  No
(FIRST BOOKING -COURTSEY Pick up & Drop off. Additional fee may be charged for mileage & time if special trip is made to pick up key on future bookings.)
Where do you want the key / garage door opener left after last visit? _________________________________________
__________________________________________________________________________________________________
(FIRST BOOKING -COURTSEY Pick up & Drop off. Additional fee may be charged for mileage & time if special trip is made to return key on future bookings.)
MEDICAL CONSENT & RELEASE
Did you complete an updated Pet Medical Consent & Release Form (template attached) or leave a letter authorizing
emergency veterinary care for the period covering this pet care assignment?  Yes  No (Optional)
PAYMENT TERMS & OPTIONS
Cash, Personal Check (Payable to: Lisa Emrich), PayPal, Chase QuickPay & QuickBooks Online payments accepted. A 4%
Service Fee is assessed on PayPal & QuickBooks online payments. See specific payment terms & options on reverse side.
Terms are based on length of pet sitting package/trip. At a minimum, 50-100% of the total fee is due at the first visit and
should be left in the home before leaving for trip. Discounts and special offers require full payment at time of first visit.
CANCELLATION POLICY
If visit is canceled within 48 hours of first scheduled/reserved visit date, a 2 Visit Cancellation Fee will be due.
ANIMAL PHOTOGRAPHY RELEASE
During the course of pet sitting and providing clients with visit updates, Lisa Emrich may photograph and take video of
your pet(s). From time to time, the photographs/video may be used for advertising or marketing purposes to promote
Lisa’s Pet Care Services. At no time will a client’s privacy, confidential information, name or home location be disclosed
in such photographs/video or publication. Lisa Emrich and/or Lisa’s Pet Care Services shall retain an irrevocable,
transferrable copyright on all pet photography/video personally taken during the course of pet sitting.
“Thank you for caring for my furry loved one(s) and for providing trustworthy and reliable services while giving them
loving and compassionate attention during this time that I will be away from them. “
X. ______________________________________________________
PET PARENT’S SIGNATURE
Lisa’s Pet Care Services / (702) 292-4950 / EmrichLisa@cs.com / www.LisasPetCareServices.com
DATE OF CONTRACT
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Lisa’s Pet Care Services / (702) 292-4950 / EmrichLisa@cs.com / www.LisasPetCareServices.com
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Lisa’s Pet Care Services / (702) 292-4950 / EmrichLisa@cs.com / www.LisasPetCareServices.com
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