Your Full Name:
Your Complete Address
Your City
State
Zip Code
Home Number#:
Work Number#:
Cell Number#:
Your Email:
Service Beginning Date:
Service Ending Date:
Number of Visits:
Expected departure date & time
Expected return date & time:
Do you automatically stay home if schools are closed? YesNo
If so, what school district:
Key received YesNo
Does anyone else have a key? YesNo
If so, who?
Left on final visit: YesNo
Kept by sitter for future services: YesNo
Pet #1:
Feeding Instructions For Pet #1:
Pet #2:
Feeding Instructions For Pet #2:
Pet #3:
Feeding Instructions For Pet #3:
Pet #4:
Feeding Instructions For Pet #4:
Exercise/Outside: Walks?
Leash Locations:
Type of Fence ElectricWoodChain LinkOtherNone
Pet Clean-Up: Litter box location and instructions
Pet Clean-Up: Accident clean-up instructions (particular spot remover/cleaner)
How many times a day does your pet have a bowel movement
Around what times?
Likes and Dislikes: Reaction to children
Likes and Dislikes: Reaction to other animals
Likes:
Dislikes: What might cause your pet to bite?
Does your pet have any favorite hiding places? Is so, where?
Health: Does your pet(s) require any medications? Y / N If yes, list
Any particular instructions? If yes, please explain
Rabies tags visible on pet? YesNo
Veterinarian Name, Phone # and Address
If unable to reach your vet in the event of an emergency, may we use another? YesNo
HOME CARE: Would you like any of the following services provided? There will be a small additional charge.
Indoor plants watered? If yes
Mail or Newspaper brought in? If yes, where should it be put?
Garbage/recycling taken to curb? Is so, when?
TV/Radio left on for pet(s): If so, where?
Lights rotated? If so, where?
Security check instructions:
Will anyone else be coming home during service contract period? If yes, please provide names.
Will cars will there be? If so, which ones
EMERGENCY CONTACTS:
EMERGENCY INSTRUCTIONS:
Today's date:
YOUR SIGNATURE: Please type your name
