Pet Sitter Form

Owner Information

Pet Owner(s)(Required)
Pet’s Name
Address



Boarding Dates

MM slash DD slash YYYY
MM slash DD slash YYYY



Care Taker

Pet Caretaker
I, the owner of the above-named pet, request that the above caretaker feed, exercise, groom, and provide routine care for my pet as per my oral or written instructions while I am away from home. Should an injury or illness occur to my pet that requires veterinary care during my absence, I authorize the caretaker to act as my agent in procuring essential veterinary medical care



Emergency Contact

The address and phone number(s) where an agent, relative of mine, or I may be reached are:
Name
Address



Payment Agreement

Please enter a number greater than or equal to 1.
I agree(Required)
I agree(Required)



Authorization

I authorize the veterinarian to furnish my pet with veterinary care and to provide essential medical services without my consent.(Required)
(Please check one)
In the event the attending veterinarian determines that my pet is suffering and/or is incurably injured(Required)
(Please check one)
If my pet should die or is euthanized, I request that the body be retained until(Required)
(Please check one)
I agree to pay the fees for such service.(Required)