Dog Sitting Request Form

Have you previously adopted from GRRSN? (NOTE: ONLY FAMILIES THAT HAVE PREVIOUSLY ADOPTED THROUGH GRRSN ARE ELIGIBLE FOR PET SITTING SERVICES.)*
Email*
Your Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Day Phone*
Evening Phone*
Cell Phone*
Phone Number You Can Be Reached While Traveling*
Local Emergency Contact Name*
Local Emergency Contact Phone*
Drop Off Date*
MM slash DD slash YYYY
Drop Off Time*

: Hours

Minutes

AM/PM
Pickup Date*
MM slash DD slash YYYY
Pickup Time*

: Hours

Minutes

AM/PM
Name and Breed of Dog #1*
Gender*
Spayed/Neutered?*
Age and Weight*
Name and Breed of Dog #2
Gender
Spayed/Neutered?
Age and Weight
Is Your Dog Comfortable with Children Under 6 Years of Age?*
If You Answered "No," Please Explain in as Much Detail as Possible.
Is Your Dog Current on All Vaccinations?*
Will Your Dog Be Able to Be in a Home with Other Dogs?*
If You Answered "No," Please Explain Using as Much Detail as Possible.
Will Your Dog Be Able to Be in a Home with Cats?*
If You Answered "No," Please Explain in as Much Detail as Possible.
Is Your Dog Able to Go Up and Down Stairs?*
Is Your Dog Housebroken?*
Can Your Dog be Left Alone During the Day?*
If You Answered "No," Please Explain in as Much Detail as Possible.
Will Your Dog be Safe in a Petsitting Home that has an Unfenced Pool?*
Does Your Dog Exhibit any Guarding or Aggressive Behavior?*
If You Answered "Yes," Please Explain in as Much Detail as Possible.
Your Veterinarian's Name and Office Name*
Your Veterinarian's Address*
Your Veterinarian's Office Phone*
Your Veterinarian's Home Phone*
Is Your Dog on any Medications or Does Your Dog Have any Special Medical Conditions?*
Additional Owner Comments:
Owner Signature:*
*
- I Have Read and Agree to the Privacy Policy
Name
This field is for validation purposes and should be left unchanged.

Pet must be current on all vaccinations (Rabies, Distemper/Parvo and Bordetella) 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 representatives and assigns, hereby releases GRRSN, its Board of Directors, members, officers and agents, volunteers and affiliates and/or any rescue representative charged or chargeable with responsibility or liability 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.

Reimbursement to the pet sitting family for damages caused by a visiting dog may be the responsibility of the dog’s owner.

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