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Offering Email Picture Pet Sitting for your peace of mind.

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Veterinary Students/Assistants Pet Care, LLC

ePicture Pet Sitting, LLC

Pet Nursing, LLC

 

Client Information
                                                                                     (for midday clients)
Owner1: ________________________ Work Schedule: _____________________#_______________


Owner2: ________________________ Work Schedule: _____________________#_______________


Street Address: ___________________________________________


City, State, Zip: ___________________________________________


Home Phone: _________________Cell Phone: ________________ Email: ______________________

Alarm System: Yes / No If Yes, Sitter Code: ___________Off ___________Away___________


Hidden key location: __________________________________________________________________


Others with keys: _____________________________________________________________________

Emergency contact 1: __________________________________________________________________


Emergency Contact 2: _________________________________________________________________


Emergency Vet Service: _________________________Preference_____________________________


Location of Necessities: Leash _________, Treats __________, Cleaning _______________________


Circuit Breaker ___________, Main Water Valve ______________, Gas Cut-Off ________________

 

Special Instructions: ______________________________________________________________________________________

______________________________________________________________________________________

Pet Information


Pet 1: ___________Breed____________ DOB:______________ Male / Female Spayed / Neutered


Licensed: __________________ City / County _______________


Veterinarian: ____________________Address: __________________Phone: ____________________


Rabies Given: ______________ Vaccine Due: ________________ Complications: _______________


DHLPP Given: ______________Vaccine Due: ________________ Complications: _______________


Bordatella Given: ____________Vaccine Due: ________________ Complications: _______________


Heartworm Test + / - ________ Method/Brand: _______________________


Flea medications Yes / No       Method/Brand: ______________Fecal: ______________


Conditions: _________________Medications: _____________________________________________


 

 

Allergies: ___________________Surgeries: ____________________Treatment: _________________


Traumas: ___________________Fears: _____________ How to handle: ________________________


Special Needs: ________________________________________________________________________


Exercise Preferences: __________________________________________________________________


_____________________________________________________________________________________

 

Restrictions: __________________________________________________________________________


Toys: _______________________ To be left with: _______________ Not alone: __________________


Food Brand: __________________ Feeding Schedule: ______________________________________


Treats allowed: ________________ Treats Not allowed: ______________________________________


Neighborhood Buddies: _________________ Enemies ______________________________________


Services Requested: _______________, ________________, ________________, _________________


Price agreements: _______________, _________________, ________________, __________________


Previous Boarding Facility: _______________________________________ Dates: ________________


Previous Pet Sitters: _____________________________________________ Issues:________________


Special Instructions: ____________________________________________________________________

 

_______________________________________________________________________________________

 

_______________________________________________________________________________________

 

Pet 2: ___________Breed____________ DOB:______________ Male / Female? Spayed / Neutered?


Licensed: __________________ City / County _______________


Veterinarian: _______________ Address: ______________________ Phone: ____________________


Rabies Given: ______________ Vaccine Due: ________________ Complications: _______________


DHLPP Given: ______________Vaccine Due: ________________ Complications: _______________


Bordatella Given: ____________Vaccine Due: ________________ Complications: _______________


Heartworm Test + / - ________ Method/Brand: _______________________


Flea medications Yes / No       Method/Brand: ______________Fecal: ______________


Conditions: _________________Medications: _____________________________________________


Allergies: ___________________Surgeries: ____________________Treatment: _________________


Traumas: ___________________Fears: _____________ How to handle: _______________________


Special Needs: ________________________________________________________________________


Exercise Preferences: __________________________________________________________________


Restrictions: _________________________________________________________________________


Toys: _______________________ To be left with: _______________ Not alone: _________________


Food Brand: __________________ Feeding Schedule: _______________________________________


Treats allowed: ________________ Treats Not allowed: _____________________________________


Neighborhood Buddies: _________________ Enemies _______________________________________


Services Requested: _______________, ________________, ________________, ________________


Price agreements: _______________, _________________, ________________, ________________


Previous Boarding Facility: _______________________________________ Dates: _______________


Previous Pet Sitters: _____________________________________________ Issues: _______________


Special Instructions_______________________________________________________________


 


Pet 3: ___________Breed____________ DOB:______________ Male / Female? Spayed / Neutered?


Licensed: __________________ City / County _______________


Veterinarian: ____________________Address: __________________Phone: ____________________


Rabies Given: ______________ Vaccine Due: ________________ Complications: _______________


DHLPP Given: ______________Vaccine Due: ________________ Complications: _______________


Bordatella Given: ____________Vaccine Due: ________________ Complications: _______________


Heartworm Test + / - ________ Method/Brand: _______________________


Flea medications Yes / No       Method/Brand: ______________Fecal: ______________


Conditions: _________________Medications: _____________________________________________


Allergies: ___________________Surgeries: ____________________Treatment: _________________


Traumas: ___________________Fears: _____________ How to handle: _______________________


Special Needs: ________________________________________________________________________


Exercise Preferences: __________________________________________________________________


Restrictions: _________________________________________________________________________


Toys: _______________________ To be left with: _______________ Not alone: _________________


Food Brand: __________________ Feeding Schedule: _______________________________________


Treats allowed: ________________ Treats Not allowed: _____________________________________


Neighborhood Buddies: _________________ Enemies _______________________________________


Services Requested: _______________, ________________, ________________, ________________


Price agreements: _______________, _________________, ________________, ________________


Previous Boarding Facility: _______________________________________ Dates: _______________


Previous Pet Sitters: _____________________________________________ Issues: _______________


Special Instructions_______________________________________________________________

 

 

 

Contract for Services

 

I, ____________________, understand that Veterinary Students Pet Care Service (“Veterinary Students, LLC”) and ePicture Pet Sitting, LLC are committed to making my life, and my pet’s life, easier by providing in-home pet care to ______________Pet's Name, _______________additional Pets: ___________________,__________________,__________________and ________________.

VAPC, Veterinary Students , Pet Nurses and pet sitters are not licensed Veterinarians, or Technicians, or working for any particular DVM or other firm at this time.

Veterinary Students are sharing their experience and knowledge base for my family and pets. Services are earning college money and helping the community. There are areas and skills that  I understand are not to be substituted for Veterinary Office visits.

 

 I herby submit consent to confer with my pet’s other care providers, doctors, etc.  

Providers include but are not limited to  _______________________________________________________________________________________

VAPC-Veterinary Students and ePicture Pet Sitting agree to provide services in a reliable and trustworthy manner at times as requested by myself in either an oral (i.e., by telephone) or in written manner to the Veterinary Technician Students or ePicture Pet Sitting's business office. Any requests and changes (including information on the Pet and Client Profile forms) not reported to and confirmed by the Veterinary Students, Pet Nursing or ePicture Pet Sitting's office will not be honored and Veterinary Students, ePicture Pet Sitting, its' walkers, associates or employees will not be held liable for any claims or damages. I agree to provide, and wish to have used, my own devices, leashes, collars, supplies for my pet's care, etc and hold harmless Veterinary Technician for problems arrising by my items and assume responsibility for my pets actions.

Veterinary Students and ePicture Pet Sitting, and Pet Nurses may take my pets on outings, Car-rides, Dog parks, Pet Stores, Vet appointments, Groomer appointments, Socialization, Obediences training, etc, and all below on my behalf:

_______________________________________      ______________________________________

(Initial_______)

Condition of Pet
Vaccine records will be submitted to VAPC, Veterinary Students/Assistants, Pet Nurses and ePicture Pet Sitting and also have been notified of condition of my animal(s) before and during service. I agree to have my pets properly immunized against all contagious diseases, parasites, etc in order to not contaminate others. Bordetella, Rabies, Distemper (DHPLP) Feline Distemper, Feline Rabies, Feline Leukemia, are required. All others for Aviary and Exotics included.
Heartworm tests, fecal exam (cats and dogs), FIP, FIV and Feline Leukemia testing must be performed on schedule.
Mange prevention in Virginia is a strong concern. I understand the need for all pets to be protected while in their care and that Revolution is recommended if applicable to my pet’s specific health condition to prevent the spread of microscopic organisms. If my animal is not kept current, Veterinary Students and ePicture Pet Sitting have my consent to perform whatever they feel comfortable with if scarcoptic mites are suspected. VAPC/VSPC and EPPS will not visit my pet if there is obvious hair loss untill successful treatment for mange and mites has taken place. This is for prevention of spread to all clients. They also may take my pet to a local DVM for these services and I will be responsible for payment of charges incurred. I agree now to pay the veterinarian and have the charge on my own personal Veterinary Account therein.

(Initial_______)

Payment for Services
I have been advised by VAPC, Veterinary Students, Pet Nurses, and ePicture Pet Sitting of its fees for rendered services and I agree that I am fully responsible for payment due in full at the conclusion of each appointment. Arrangements can be weekly, bi-weekly and monthly. I hereby authorize Veterinary Students to Charge

_________for walks, _________for visits, _________ for medication administration,

________for nail clipping, ________for bathing, ________for waste removal,

__________for Taxi Service, _________Overnights, _________Holiday Service, __________

Weekend Sevice, and ________________Service, _________________Service, __________ ________Service. 

 

VAPC, Veterinary Students and ePicture Pet Sitting will not proceed with caring for my pet with out payment first. Payments are to be made the same day of service.

Mondays are when weekly acounts are due. I also agree that all cost, including emergency and/or medical costs, medication costs and food costs, incurred by Veterinary Students or ePicture Pet Sitting during the care of my pet is my responsibility and I will reimburse Veterinary Students for said costs. (Initial ______)

Pre-Paid Monthly Service   (M-F single dog walks/visits $250 package, local to sitter only)
If I elect to be a Pre-Paid Monthly client, or agree to a monthly service agreement, I agree and understand that I am responsible for an entire month’s payment for services unless cancellation.
Please give at least 24 hours notice, exceptions will be given in case of emergency, or contagious illness. (in which case, warn us away  :)
Payment is due the first of the month for monthly service. I will receive 1 regularly scheduled Monday-Friday daily appointment(s) between the hours of 9am – 5pm within one-half hour of the agreed upon appointment time. I understand that it is my responsibility to notify the Veterinary Students office if pet(s) will not be home. Pre-Paid Monthly contracted service does not include the following holidays: New Year’s Eve, New Year’s Day, Easter, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Christmas Eve and Christmas Day. Veterinary Students amd ePicture Pet Sitting will not provide services on these days unless asked to do so and specifically, booked and confirmed in advance. I understand that Veterinary Technician Students and ePicture Pet Sitting follow the Federal Government’s Inclement Weather Policy (Initial______)

Medical Authorization/Power of Attorney (we WILL attempt to reach you FIRST)
As the owner of the pet/animal, I hereby grant VAPC, Pet Nursing, Veterinary Students/Assistants, ePicture Pet Sitting, its employees, agents and/or Independent contractors, the authority to render all care and make decisions with respect to the health and well-being of the above-named pet(s). This power and authority shall extend to and include the authority to make decisions with respect to the feeding, and sheltering of the above referenced animal(s); the authority to seek appropriate medical treatment or attention on behalf of the above referenced animal(s) as may be required, including but not limited to, veterinary, and/or emergency care; and the power to authorize medical treatment and/or procedures in the course of any veterinary and/or emergency care. If I should not return they will continue service and assume all property to secure my pet and it's future care.
This power and authority also includes authorization to place any charges incurred by the above itemized care by any veterinary doctor and/or clinic, emergency animal clinic and/or other care giver, in the course of any necessary treatment, to be placed on my account which will be paid upon my return, or, in the event an account cannot be established, I understand Veterinary Students and ePicture Pet Sitting will pay a maximum of $200.00 to begin veterinary treatment and will demand the best comprehensive veterinary diagnostics, treatment on my behalf. Additionally if the Vet even mentions there might be a reason to perform a procedure I agree to fully reimburse Pet Nursing, Veterinary Students/Assistants and ePicture Pet Sitting for all necessary charges incurred in the care of the above referenced animal(s) in the acknowledgment that I am solely responsible for the payment of all necessary costs incurred with respect to the care of the above referenced animal(s). (Initial_______)
 

Key Release
I hereby authorize a representative of VAPC, Veterinary Students and ePicture Pet Sitting to use my house key(s) during the time she/he will be caring for / visiting my pets. I understand that it is my responsibility to provide two (2) working sets of duplicate house keys and any applicable alarm information. (Initial_______)


Liability
I agree that VAPC, Veterinary Students, Pet Nursing and ePicture Pet Sitting, its employees, agents and/or contractors, will not be held liable to me or anyone who may claim right,, due to relationship with me, for any circumstances beyond their control, including but not limited to an unforeseen eating/swollowing foreign bodies, attacks, escapes, illness, injury, accidental death or reaction to veterinary treatment, damage to property or for the acts or omissions in the performance of services on the part of Veterinary Students, ePicture Pet Sitting, its employees, agents or contractors, even if such acts or omissions are due to willful misconduct.

*Humans are held responsible as individuals by the law.

Also, permission is only granted for these people to be on premisis without alerting me or Police:

________________________  and  _______________________and ______________________________

No Veterinary Student or ePicture Pet Sitter will be held liable for my guests, family members, tenants, or their effect on my home, pets, etc. (Initial_______)

 

I understand that all animals are cared for by  VAPC, Pet Nursing, Veterinary Students/Assistants and ePicture Pet Sitting, without liability on its part for loss or damage from, but not limited to, disease, death, running away, theft, fire, injury to persons or other animals, or damage to property by my pet(s) or other unavoidable circumstances. I indemnify and hold all of Veterinary Students and ePicture Pet Sitting free and harmless from any obligations, costs, claims, judgments, attorney fees and attachments arising from or in any way connected with services rendered to me. (Initial_______)


This contract shall remain in force under the laws of the Commonwealth of Virginia until written notification of cancellation is received by Pet Nurses, Veterinary Students/Assistants or ePicture Pet Sitting.
I have read and understood the above terms and I agree to abide by the terms as set forth with the understanding that it is set forth to provide the best care for my home and pets.

____________________________________________ ___________________________
Client Printed Name                                                                 Date

____________________________________________


Client Signature

___________________________

Credit Card Number

_____/_____

Exp Date

Thank you so much for using Pet Nursing and ePicture Pet Sitting, LLC…

Great pet care is our calling!
Sincerely,

_________________________________________
Cristinea “Crissie” Kelley
President Member, Veterinary Students/Assistants/Nursing Pet Care, LLC.

ePicture Pet Sitting, LLC.

crissie@vapc.com

 

Veterinary Students/Assistants/Pet Nursing, LLC.

& ePicture Pet Sitting, LLC.
4538 Garbo Ct.
Annandale, VA 22003
703-863-2067

www.VAPC.com                                                  11/08