Your Name

Your Street Address

City

State

Zip

Your Home Phone

Your Work Phone

Your Cell Phone

Your Email Address:

Emergency Contact 1 (In event you cannot be reached)

Emergency Contact 1 Phone

Emergency Contact 2 (In event you and contact 1 cannot be reached)

Emergency Contact 2 Phone

Vet Info

Your Veterinarian's Name

Your Veterinarian's Address

Your Veterinarian's Phone

Any Known Medical Conditions

Vet Treatment Maximum Dollar Value

During my absence, Leash On Command, LLC. will be caring for my pet(s). In the event of an emergency, I authorize you (veterinarian) to administer medical treatment and will be responsible for payment to you (veterinarian) upon my return.

I give Leash on Command, LLC. permission to transport my pet(s) to the above veterinarian and authorize treatment in the event of an emergency or sickness.

If this veterinarian is not available, I authorize Leash on Command, LLC to transport my pet(s) to a veterinarian of choice and authorize treatment. If emergency care is needed after regular office hours, my pet(s) may be taken to the nearest Veterinarian Emergency Hospital.

I give my permission to Leash on Command, LLC. to approve treatment up to the value set above

I agree to be responsible for all charges upon my return including, but not limited to, vet fees, extra visit fees and transportation fees.

I agree that Leash on Command, LLC is released from liability related to transportation to and from veterinarian and treatment for sickness or emergency.

This release will remain valid for all current and future visits unless a new release is signed. By selecting "Yes" below, you agree you've read this entire vet release and agree to its terms in entirety.

Do you agree?
I'm still readingYes I have read the vet release form and agree to its terms

Pet Info

Pet Name

Gender
SelectMaleFemale

Breed

Color/Markings

Leash / Collar - Descriptions & Locations

Walk Pointers / Special Instructions

Precautions (Other Dogs, People, Allergies)

Weather Restrictions

Other Info

By submitting this form, you verify the following representations about your pet.

I, the signer of this application, am the only owner of the dog SelectTrueFalse

My dog is current on rabies shots and vaccinations SelectTrueFalse

My dog is healthy enough to enjoy a walk SelectTrueFalse

My dog is friendly toward children and adults SelectTrueFalse

My dog is friendly toward other dogs and other animals SelectTrueFalse

My dog is not nursing puppies SelectTrueFalse

My dog has never bitten a person SelectTrueFalse

My dog has never been declared a dangerous dog or potentially dangerous dog, or a vicious animal SelectTrueFalse

My dog does not have to be muzzled around people SelectTrueFalse

My dog is not a trained guard dog or protection dog SelectTrueFalse

Do you agree to all these statements?
I'm still readingI agree to all the pet representations mentioned on this page

By selecting "Yes" below, I agree that I have downloaded, read, and agree to our contract that will open in a new window by clicking this link: Leash On Command Contract

Do you agree to all these statements?
I'm still readingYes I have downloaded read, and agree to the Leash On Command contract available on the link provided above