Leominster, MA’s Premiere Dog Walking and Cat Sitting Company

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Cat Owner name ___________________________

Address ___________________________________

Home phone number ________________________

Cell phone number __________________________

Email address ______________________________

Emergency contact if owner not available _____________________________________

Cat’s name ________________________________

Breed _____________________________________

Age ________________

Veterinarian contact information ____________________________________________

How long have you owned your cat? ___________

Is your cat healthy enough to receive visits from a member of The Unbound Hound? Yes ____ No ___

Is your cat up to date with his/her vaccinations? Yes ____ No ____

Please list all of your cat’s medical conditions, dietary issues, and allergies, and any other health-related concerns: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Please list any particular fears your cat has: ______________________________________________________________________________ ______________________________________________________________________________

Are there any other needs or concerns we should be aware of? ______________________________________________________________________________

Has your cat ever bitten, scratched, or otherwise injured a person, cat or dog, or other animal? Yes ___ No ___
If yes, please indicate when this occurred and describe the circumstances. ______________________________________________________________________________ ______________________________________________________________________________

Has your cat ever caused serious property damage? Yes ____ No ___ If yes, please describe when this occurred and the nature of the damage. ______________________________________________________________________________ ______________________________________________________________________________
Has your cat ever suffered an injury requiring medical treatment? (such as being hit by an automobile, injured by another animal, etc.) ___ Yes ___No If yes, please describe what happened. ______________________________________________________________________________ ______________________________________________________________________________


I __________________ acknowledge and accept that my cat _____________ (of whom I am the legal owner) will be participating in the cat sitting and other related services provided by The Unbound Hound LLC. I understand that The Unbound Hound will strive to protect the safety of my cat, but that there are risks involved that are out of The Unbound Hound control. These include, but are not limited to: injury or death to my cat caused by another dog or animal, an automobile or other source, injury or death to another cat or animal, or a person, caused by my cat; property damage caused by my cat; ingestion of items causing injury or death to my cat. I understand that it is The Unbound Hound’s goal to provide a safe and loving experience for my cat, but that these inherent risks still exist. I also understand that it is my responsibility to be truthful in completing the above information and disclosing any past history of aggressive behavior which my cat has. On behalf of myself and my representatives, I hereby waive, release, discharge and agree to hold harmless, defend and indemnify Christina de Andrade, The Unbound Hound, and its owners, managers, members, officers, employees, contractors, agents, assigns, and representatives, from any and all liability of any kind for injuries, losses, damages, claims, demands, arising out of and/or related to my animals participation in pet sitting services and other activities at or through The Unbound Hound. In the event of injury or illness involving my cat, I authorize The Unbound Hound to administer CPR or first aide and/or seek medical treatment if it deems this necessary. I agree that I am financially responsible for any such medical treatment. The foregoing information is true and accurate, and I will notify The Unbound Hound if any of the above information changes.

Cat Owner Signature __________________________________________ 

Date ____________