This agreement is made on (date): ___________________
Purpose of Agreement: The purpose of this agreement is to state the duties and obligations of the Handler and Owner respectively, concerning the care and handling of the below listed pet(s).
Handler: Marie Theiss. Associate Handler: Ken Theiss. Associate Handler:____________________
Owner(s) Name: __________________________________________________________________
Home phone :___________________________Work Phone: _______________________________ Cell Phone: ____________________________
If out of Country, E-Mail:____________________________________________________________
Subject of Agreement: The animals, which are the subject of this agreement, are fully described below. The Owner hereby affirms that the information provided is true and correct, and agrees to indemnify and hold harmless for any damages that may result to the animals, to Handler or Associate Handlers, to Owner, or to third parties from inaccurate information being provided herein:
Color: _________________________________________ Sex: Male Female (circle)
Date(s) of birth: ___________________________________________________________________
Chronic Illnesses: ________________________________________________________________
Flea and Tick prevention:___________________________ Current: Y N
Date(s) of last rabies vaccination: ____________________________________________________
Date(s) of last Bordetella vaccination:_________________________________________________
Please provide copy of vaccination records
Behavior information about animal(s)
Fully describe previous displays of aggression of any type, for expel, aggression towards other animals or people, food/treat aggression, and or toy aggression:
Authorization: Owner hereby authorizes and empowers Handler or Associate Handlers to walk/exercise the animal(s) listed in the designated locations and public areas, to enter the owner’s residence and feed the animal(s).
Indemnification and Hold Harmless: Owner hereby agrees to indemnify and hold harmless Handler or Associate Handlers from any and all liability that may result from the following:
• Any injuries inflicted by the named animal(s) or other animals on Handler, Associate Handler or on third parties
• Any injuries that may be suffered by the named Animal(s)
• Any destructive behavior in the house/house soiling (Valuables and sentimental items should be safely stored.)
Emergencies: In the event that such emergency medical care is necessary for the named animal(s), it is agreed that the Handler or Associate Handler will obtain treatment from any licensed veterinarian, the expense of which will be reimbursed by the Owner within two business days.
Emergency contact name and numbers: _____________________________________________
Cleaning procedures/solutions: Owner must choose and leave the appropriate carpet cleaner for the
Handler or Associate Handlers. Food dyes and natural pet body fluids can bleach and/or stain carpeting and are beyond the Handler or Associate Handler’s control.
Keys: Owner must provide an operating key for the Handler or Associate Handler to use to enter the residence or location of the animal(s). The practice of hiding a key or keys is strongly discouraged by the Handler and Associate Handlers. The Owner assumes responsibility of all outcomes in the event he or she desires to “hide” a key(s).
Miscellaneous: Please make available a towel to dry your pet(s) on rainy days. Please write feeding directions on back of this agreement if we will be feeding your pet(s).
Please list any person(s) who will be in your home during daily pet walks/care and any person(s) who will be in your home at any time during your extended absence while your pets are in our care. (ie. relatives, friends, cleaning crews etc.)_________________________________________________
Owner Name: ___________________________________________________________________
Owner’s Signature: ____________________________________________ Date: ______________
Handler’s Name: _________________________________________________________________
Handler’s Signature: ___________________________________________ Date: ______________