Please complete this Dog Sitting Information, Waiver/Release and Medical Authorization Form so that we may find the perfect Pet Sitter for your companion.   It makes going on vacation a whole lot easier!

* Required fields
Name *
E-mail Address *
Street Address *
City, State, Zip *
Day Phone *
Evening Phone *
Phone Number where you can be reached while traveling *
Local Emergency Contact Name *
Local Emergency Contact Address *
Local Emergency Contact Phone Number *
Name of Dog *
Breed *
Gender *	FemaleMale
Spayed/Neutered? *	YesNo
Age and Weight *
Does your dog live with children? *	YesNo
If yes, what age(s)?
Is your dog comfortable with children under 6 years old?	YesNo
Does or has your dog live(d) with other dogs? *	YesNo
Will your dog be able to be in a home with other dogs? *	YesNo
Does or has your dog live(d) with cats? *	YesNo
Will your dog be able to be in a home with cats? *	YesNo
Can your dog go up and down stairs? *	YesNo
Does your dog currently have a fenced yard? *	YesNo
Is your dog housebroken? *	YesNo
Is your dog crate trained? *	YesNo
Is yor dog comfortable in a restricted environment? *	YesNo
If yes, please list (i.e. baby gate, separate room, etc.
Does your dog require that someone be home during the day? *	YesNo
Does your dog require that it be let out in the middle of the day? *	YesNo
How much and what kind of daily exercise does your dog currently get? *
Does your dog relieve him/herself in any special manner? *	YesNo
If yes, please indicate circumstances (i.e. on "command", on leash, off leash, on a walk, etc.
Please indicate your dog's favorite toys, games or behaviors *
What obedience commands does your dog understand? *
Does your dog demonstrate any nuisance behaviors such as Jumping, Barking,etc. Explain. *
Does your dog demonstrate any aggressive behaviors? Explain *
Does your dog demonstrate any guarding behaviors? Explain *
Is your dog sensitive to any touches, noises or circumstances? Explain *
Does your dog ride well in the car? If no, explain *
Dog #1 Brand of food, Feeding Time, Amount of Food *
Dog #2, Amount of Food
Do you give your dog rawhides? *	YesNo
Do you give your dog pigs ears? *	YesNo
Veterinary Facilty Name *
Veterinarian's Name *
Veterinarian's Address, *
Veterinarian's Phone *
Is your dog on any medications? Please list dosages how to administer *
Does your dog have any special medical conditions? Please indicate *
Additional OWNER Comments
Signature /S/ *
I have read and agree to the Privacy Policy *

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Pet must be current on all vaccinations (rabies, distemper series and bordatella) and proof provided.

In the event Pet becomes sick or injured, the GRRSN Dog Sitter Volunteer will make every reasonable effort at attempting to contact owner or that person that the owner has named as local emergency contact prior to getting medical attention; however, if Volunteer is unsuccessful at such attempts and feels that it is in the best interest of the Pet to seek immediate medical attention, Dog Sitter Volunteer will seek such medical attention.  If the undersigned’s personal veterinarian is not available, the undersigned authorizes the Dog Sitter Volunteer and/or GRRSN to get the necessary medical treatment as required, and the undersigned further agrees to be responsible for all such expenses resulting from such treatment.  The undersigned further agrees to reimburse  Dog Sitter Volunteer and/or GRRSN for any out-of-pocket expenses at the time Pet is picked up; or, in the alternative, will supply Volunteer (or the veterinary center where Pet is being treated) with a valid credit card for payment of any medical services.

 The undersigned assumes all risk related to having their dog cared for by GRRSN.  The undersigned with intention of binding applicant, spouse and my (our) heirs, legal represntatives and assigns, hereby releas GRRSN, its Board of Directors, members, officers and agents, volunteers and affilaitesand/or any rescue representative charged or chargeable with responsiblity  or liabiltiy from any and all claims, actions, liabilities, damages, costs, expenses, loss of service ,actions/causes of action that undersigned ever had, or now has, or may have, known or unknown, or that anyone claiming through or under applicant may have or claim to have against GRRSN, its officers, directors, participants, members, volunteers, and affiliates arising out of any work or activity with any dog connected with GRRSN or a dog owned by GRRSN. 

I undersnd and agree to adhere to the terms listed in this contract.