Pet Sitting Veterinary Medical Care Release Form
In the event of a medical emergency , we will attempt to contact you or your designated emergency
contact by phone. If we cannot contact you (or them) by phone, this form will allow your pet sitter to
provide care for your pet.
My Information (or emergency contact)
Name: _________________________________________
Significant Other: __________________________________________
Address: _____________________________________________
Home phone: ____________________________ Cell phone: ___________________________
Pet Information
Name: ________________________ Breed: ____________________ Color: ______________
Name: ________________________ Breed: ____________________ Color: ______________
Name: ________________________ Breed: ____________________ Color: ______________
Name: ________________________ Breed: ____________________ Color: ______________
Primary Veterinary Information
Name of Clinic: _________________________________________
Address: _______________________________________________
Phone number: ______________________________________
I, _______________________________________________________ (pet owner) hereby give
______________________________________ (pet sitter) my express permission to take my pet(s) to
the above-mentioned veterinarian (or to the closest open facility if the primary vet is not available). I give
permission for the veterinarian to administer any care or medications necessary. I will assume full
responsibility for the payment for any and all veterinary services provided.
Signed: __________________________________________ Date: ___________________