Name: First Last Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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? Yes No Rabies tag #: Date rabies shot expires: 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? Yes No Rabies tag #: Date rabies shot expires: 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? Yes No Rabies tag #: Date rabies shot expires: 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? Yes No Rabies tag #: Date rabies shot expires: 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? Yes No Rabies tag #: Date rabies shot expires: 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? Yes No So So How 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? Yes No If 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 No Likes new adults? Yes No Likes children? Yes No Dogs:Does your dog need a special harness or choke collar for walks? Yes No Must stay on leash during walks? Yes No Is allowed in the house? Yes No Is allowed to have treats? Yes No Is prone to digging? Yes No Is prone to chewing? Yes No All Animals:Is fearful of noises or other things? Yes No Obeys basic commands? Yes No Has bitten people or other animals? Yes No Has shown other aggression? Yes No Likes to be petted? Yes No Cat Questions:Is your cat allowed outdoors? Yes No Likes to be held? Yes No Declawed? Yes No Tries to escape? Yes No Will not eat when stressed? Yes No Prone to hairballs? Yes No Skittish with strangers? Yes No Uses the litter box reliably? Yes No Please 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.
