Name: First Last Address: Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone:Cell Phone:Work Phone:Emergency Contact (other than owners): First Last Phone:Location of Extra Key:Alarm Deactivation Code:Alarm Activation Code:Alarm Company Name:Alarm Company Phone: What Kind of Pets Do You Have? Dog Cat Bird Saltwater Fish Tank Freshwater Fish Tank Hamster Rabbit Turtle Guinea Pig Chinchilla Ferret Other Additional Duties (please check those you would like to request): Bring in mail/papers Put out trash/recycling Water plants Other Pet Information:Please complete for each pet (up to 5).Pet #1 Name: Breed:Color:ListSex:Birthday:Weight:Is the animal spayed or neutered?YesNoRabies tag #:Date rabies shot expires: Date Format: MM slash DD slash YYYY How old was the animal when you got them? Pet #2 Name: Breed:Color:ListSex:Birthday:Weight:Is the animal spayed or neutered?YesNoRabies tag #:Date rabies shot expires: Date Format: MM slash DD slash YYYY How old was the animal when you got them? Pet #3 Name: Breed:Color:ListSex:Birthday:Weight:Is the animal spayed or neutered?YesNoRabies tag #:Date rabies shot expires: Date Format: MM slash DD slash YYYY How old was the animal when you got them? Pet #4 Name: Breed:Color:ListSex:Birthday:Weight:Is the animal spayed or neutered?YesNoRabies tag #:Date rabies shot expires: Date Format: MM slash DD slash YYYY How old was the animal when you got them? Pet #5 Name: Breed:Color:ListSex:Birthday:Weight:Is the animal spayed or neutered?YesNoRabies tag #:Date rabies shot expires: Date Format: MM slash DD slash YYYY How old was the animal when you got them? Veternarian:Name First Last PhoneHow long is your animal left alone during the week?Where are the animals during the day? (crate, kitchen, backyard):Is your animal house trained?YesNoSo SoHow does your animal react to strangers?Feeding:What kind of food(s) does your animal eat?When does your animal eat?Special feeding instructions: Medication:Is your animal on any medications that must be administered?YesNoIf yes, please describe the medication procedures including name, dosage, and where it is kept. All Animals:Does your animal have a favorite game?Does your animal have a favorite hiding place or places?Where do you keep your collar, leash, food, toys, scooper?Does your animal have favorite toys?Is there something that will bring your cat out of hiding (the sound of the can opener or treat jar, for exaple)? Traits:Please answer the following brief questionnaire about your animals. It will help us to better care for him/her:Is friendly with other animals?Yes NoLikes new adults?Yes NoLikes children?Yes No Dogs:Does your dog need a special harness or choke collar for walks?Yes NoMust stay on leash during walks?Yes NoIs allowed in the house?Yes NoIs allowed to have treats?Yes NoIs prone to digging?Yes NoIs prone to chewing?Yes No All Animals:Is fearful of noises or other things?Yes NoObeys basic commands?Yes NoHas bitten people or other animals?Yes NoHas shown other aggression?Yes NoLikes to be petted?Yes No Cat Questions:Is your cat allowed outdoors?Yes NoLikes to be held?Yes NoDeclawed?Yes NoTries to escape?Yes NoWill not eat when stressed?Yes NoProne to hairballs?Yes NoSkittish with strangers?Yes NoUses the litter box reliably?Yes NoPlease indicate anything else about your animal's habits or behavior that would be useful to us in providing care. * I agree that all of the information on this application is true to the best of my knowledge.
