New Client Reservation Form

New Client Reservation Form©
Absolutely no parts of this form may be reproduced by other petsitters without written permission from I Care Petcare!

If you are an existing client, have already provided the information below,
and wish to make reservations for additional services, please use the Existing Client Reservation Form.

Use your TAB key to move from box to box. Do NOT use your enter key as pressing enter will submit your form prior to completion! Please fill out the form completely (be specific). This form only needs to be filled out once; the information you provide will be used for all future visits. Please read the Services/Rates/Policies page prior to filling out this form. Submission does not automatically guarantee services can be provided. I will email you within 24 hours to confirm availability. Please contact me if you have any questions.

A. INFORMATION ABOUT YOU

Your full name: Street address (incl apt., upper/lower, etc.): City: State: Zip code:

Email: Cell: (include area codes) Home Phone:

Approx. # times/year you will need me: Name of referring vet, friend, or other source:
Who previously cared for your pets (neighbor, friend, family, prof. petsitter--if pro, list business name)?:
Reason you no longer use the aforementioned:

B. INFORMATION ABOUT THE SERVICE YOU REQUIRE

Date and time of my first visit:
Date and time of my last visit:
When are you leaving your home (not flight time)?
When are you returning to your home (not flight time)?
Petsitting service desired: Visit length needed: Number visits per FULL day needed:
Total # visits THIS trip: Rate per visit: Total amount due (include set-up fee) $

C. INFORMATION ABOUT YOUR PETS

Pet #1: Pet name: Species/Breed (Cat/Siamese, Bird/Cockatiel) Description (color, identifying marks, etc.): Sex: Birth year:

Feeding instructions (Be VERY specific! Include exact amount of dry and/or canned, seed, veggies, and normal feeding times)
Medication (Be VERY specific! Include name of med, type (pill, liq, crm, shot), reason for med, times meds are normally given, dosage EACH time, and any tricks to giving it or other important info:
List here any other medications given to this pet including ALL of the information above:
Health concerns of this pet (other illness, lumps, eye discharge, injuries, limps, etc.): Be specific.
Has "accidents" vomits regularly has hairballs bites tries to "escape" through door Where would pet go if "escaped"
Other things I need to know about this pet (favorite activities, temperament, hiding places, etc):

Pet #2: Pet name:                       Species/Breed (Cat/Siamese, Bird/Cockatiel)      Description (color, identifying marks, etc.):                              Sex:         Birth year:

Feeding instructions (Be VERY specific! Include exact amount of dry and/or canned, seed, veggies, and normal feeding times)
Medication, if applicable: Name of med: Type (pill, liq, crm, shot):  Reason:
ALL times meds are normally given: Do meds NEED to be given at an exact time? Dosage EACH time:
How to administer/tricks: Ease of giving meds:
List here any other medications given to this pet including ALL of the information above:
Health concerns of this pet (other illness, lumps, eye discharge, injuries, limps, etc.): Be specific.
Has "accidents" vomits regularly has hairballs bites tries to "escape" through door Where would pet go if "escaped"
Other things I need to know about this pet (favorite activities, temperament, hiding places, etc):

If you have more than two pets, list here the same information as above for each additional pet:

E. INFORMATION ABOUT YOUR VETERINARIAN

Veterinarian, clinic, or hospital: Complete Address: Day phone: After hours:
Names of pets treated here: I authorize vet expenses up to (please fill in): $ Treatments you do not authorize or more info.: I DO/do NOT authorize euthanization in extreme circumstances under veterinarian advisement after all reasonable attempts have been made to contact me. If you have more than one vet, list here the same information as above for each additional vet:

Typed Name: Signature (required at set-up meeting): Date:

F. INFORMATION ABOUT THE LOCATION OF SUPPLIES (BE SPECIFIC!)

ALL pet food: Meds: Carrying crate: Litter /box/scoop: Bags for waste: Rags/paper towels: Cleaning solution (brand) for "accidents" Broom AND dust pan/mop Watering can: Thermostat: Flashlight: Fire extinguisher: Circuit breakers: Main water valve: Anything else:

G. INFORMATION ABOUT THE CARE OF YOUR HOME

Check services you want: Alternate shades Alternate lightsBring in mailBring in paper Water inside plants (detailed instructions) Water outside plants (detailed instructions) Name/phone of who will shovel/salt:

H. INFORMATION ABOUT KEYS/ALARM SYSTEM

All precautions are taken to ensure the safety of your home and pets. Keys, alarm codes, and other personal information is kept confidential and under lock and key. I am insured and carry special bond-like coverage.

Keys (check one).
I release my keys to you to retain for future services (may be revoked at any time and keys returned).
I will pick up my key from your home after I return and I will deliver and pick up key for every future visit.

Alarm.
Name of alarm company: Phone(s): Instructions for turning alarm OFF (include your access code if can't give temporary code): Instructions for turning alarm ON (include access code if can't give temporary code):

Others authorized to be in your home while you are away.
Name/phone: Reason: Hours/days:
Name/phone: Reason: Hours/days:

I. INFORMATION ABOUT YOUR EMERGENCY CONTACT PERSON

I must be provided with the name of someone local who is authorized to make decisions on your behalf related to your pet or your home. Let this person know s/he has been listed as a contact person and the dates you will be gone. Name: Phone:

Permission is granted to board my pets if this contact person cannot care for my pets in an emergency. Boarding facility name: Address Phone

Under what circumstances do you want to be contacted: Don't call Any question Missing pet Sick pet Death of pet Household emergency

J. ANYTHING ELSE I SHOULD KNOW ABOUT OR COMMENTS/SUGGESTIONS

K. OTHER SERVICES OFFERED

Check if you are interested (additional fee). Holistic Pet Therapies (Reiki, aromatherapy). More details will be given during the setup meeting.

L. SERVICE CONTRACT

Our service contract is comprised of this reservation form and the Services/Rates/Policies page. Signing your name below will be your acknowledgement that you have read, understand, and agree to all parts of this contract and will give me permission to enter your property whenever service is needed.

I have completely read and fully understand and agree to all information contained in: Reservation Form Services/Rates/Policies

Typed Name Signature (required at set up) Date

Upon completion, click the "submit" button below. A "confirmation" page will appear that shows all the information you have submitted. Please be sure to print that page for your records, that is your copy of the reservation part of the contract. At the bottom of the confirmation page is a link that says, "Return to Form." When you click the link and return to your form, you will notice that your information has disappeared. This is because the form automatically resets after submission. After reviewing the confirmation page, if you decide you want to add more information, email me.

Within 24 hours of receiving your reservation form, I will contact you to confirm my availability and to arrange a set-up meeting. If you have not heard from me within 24 hours, please call 414-871-1851. Thank you for your time and effort in filling out this form. I strive to provide excellent care and the information you have provided will help me do just that. Call or email if you have any questions or concerns as you are filling out this form. I look forward to serving you and caring for your pets.

your completed form to me. to clear your form WITHOUT submitting it.