Pet Nanny | New Client Form Pet-Nanny

New Client Form

Date

First Name

Last Name

Address

House Number and Street Name

City

State

Zip Code

Time Leaving

Cell Phone/Pagers

Date Leaving

Time Returning

Date Returning

Referred by

Phone

Where you can be reached

Emergency Contacts

Name

Telephone

Relationship

Key to Home?

Others who have access to your home (cleaning, plumber, etc)

Location of fuse box/circuit breaker

Is security system in place?

Yes

House Access Code, Entrance/ Exit

Alarm Instructions

Garage Code

Instructions

Pets (Please click + button to add ALL pets)

Repeater Field

Pet’s Name	Sex M/F	Breed/Color	Personality	Pet DOB	Food/Diet	Meds

Vet Preference

Vet Address

Phone

Pet Food/Treats located

Toys located

How are pets secured in yard?

Leash located

Indoor Accident Clean-up Supplies?

Extra Paper Towels

Location of litter box, scoop & disposal of contents

Will Pet Nanny care responsibility be shared with anyone else during your absence?

How do pets react to your absence from home?

How do your pets react to storms/lightening?

Are you aware of any reason we should approach any of your pets with caution?

Please Note: The utmost care will be given in watching both your pet(s) and your home. However, due to the extreme unpredictability of animals, we cannot accept responsibility for any mishaps of any extra-ordinary or unusual nature (i.e., biting, furniture damage, accidental death, etc.) or any complications in administering medications to the animal. Nor can we be liable for injury, disappearance, death, or fines of pet(s) with access to the outdoors. All pets are to be currently vaccinated with proof of vaccinations(s).

Pet Nanny is paid in advance.

Payment

Cash

Check

Visa

Card Number

CCV

Expiration Date

Zip Code

Name as Signature (required)*

Name

Date

VET Notification

Dear Dr

On-going care

On-going care throughout the year.

Whenever hired by Pet Nanny, Inc.

Name(s) of Pet(s)

Exclusions

Signature

Sign Here