Intake Form

Most of our business is through referrals from friends, veterinary clinics, and by word of mouth. Please fill out this short questionnaire about your pet's shots and vaccinations, your own veterinary, food preference, allowable snacks, medications (if any) toys, favorite blankets, etc. If you are going to be away on vacation we will need to know how to get in touch with you or someone your designate, should the need arise. 





Henry Wardwell d/b/a South Beach Manor


Name ___________________________________________________________

Address______________________________ City ____________ Zip ________

Cell Phone___________________ Work______________ Cell______________

E-Mail Address____________________________________________________

Emergency Contact Name___________________ Number_________________

How did you hear about us: __________________________________________


Pet Name___________________________ Age_____ Gender_______________


I authorize Henry  Wardwell d/b/a/: South Beach Manor to act as my agent in the event of my dog needing medical attention. I further agree that I will be responsible for

any and all cost of any veterinary care deemed necessary by the licensed





(We ask only that you provide your pet's food with feeding instructions. We do have dog beds or all shapes and sizes, but no crates.)

Owner's Veterinarian:_________________________________________________


Medications or pet/s physical limitations:___________________________________

Special Feeding / Dietary instructions:____________________________________


Pet bed or crate provided: _______yes.  No________________________________

Is your dog allowed on furnature?________________________________________

Does your dog sleep in bed?___________________________________________

Does your dog get along with cats?______________________________________

How well does your dog get along with other dogs?_________________________

Any history of biting or aggressive behavior?______________________________



Person to call & phone#_______________________________________________


For the purposes of this contract the Pet Sitting service provider will be referred to as PET SITTER and the Pet Owner will be referred to as OWNER. The parties herein agree to the following terms and conditions.

1. Payment in full is due upon pick up of pet/s. Payment may be made by cash or check.

2. Cancelation policy. There is no fee or penalty charge for any cancelation, whatsoever.

3. If owner is delayed in picking up pet and won't be able to do so until late night, pick up may be made the following morning at no additional charge.

4. If Owner plans to lengthen their trip they must telephone Pet Sitter a minimum of 12 hours in advance.

5. Owner must confirm pick up time, and if there is a change notify Pet Sitter as far in advance as possible.

6. It is advisable for Owner to inform their Veterinarian that a Pet Sitting Service will be caring for their pet(s) in their

absence. If possible Owner will make arrangements to have Veterinarian reimbursed for any service

necessary during their absence by leaving their credit card # on file.

7. If a medical emergency arises for pet, Pet Sitter will make every effort to contact the Owner but if time is

of the essence Owner authorizes Pet Sitter to seek medical services at the closest Veterinarian Hospital.

Owner agrees to reimburse Pet Sitter for all services rendered by Veterinarian in accordance with Owners


8. In the unlikely event of illness or personal emergency to Pet Sitter, Owner will authorize Pet Sitter to

arrange for another qualified person to fulfill responsibilities as set forth in this contract. Owner will be

notified in such a case.

9. It is the Owners responsibility to make sure all of their pet(s) are current on their vaccinations. Should Pet

Sitter be bitten or otherwise injured by Owners pet(s), Owner agrees to pay all medical costs and lost wages

incurred by Pet Sitter due to such injury.

10. Owner is responsible for any injury caused to Pet Sitter or the general public by Owner’s pet(s) or

condition of Owner’s premises.

11. Pet Sitter will provide the services stated herein in a reliable, caring and trustworthy manner. In

consideration of these services and as an express condition thereof, Owner expressly waives and

relinquishes any and all claims against Pet Sitter except those arising from gross negligence or willful

misconduct on the part of Pet Sitter.

12. Should any section, provision or portion of the contract be held to be invalid, illegal, void or

unenforceable, then such section, provision or portion shall be deleted from this contract. The remainder of

this contract shall continue in full force and effect.

13. Any controversy or claim arising out of or in relation to this contract shall be brought to Small Claims

Court before any other action is taken. If the matter cannot be resolved in Small Claims Court then the

parties agree to binding Arbitration in accordance with the State of Florida. The arbitrator shall be

based on the rules of the American Arbitration Association.

14. This contract shall be interpreted and governed by the laws of the State of Florida  in which it is signed. Each party will perform its obligations in accordance with all the applicable laws, rules and regulations of said State.

15. No term or provision of this contract shall be waived and no breach excused verbally. To be effective,

each waiver or excuse shall be in writing and signed by the party who waived or excused.

16. Each waiver or excuse shall be independent of all other. Therefore, if a term or provision is waived or

breach is excused, that waiver or excuse shall not waive any other term or provision or excuse any other


17. In no event will Pet Sitter be liable to Owner for any damages, including, but not limited to any lost

profits, lost savings or their incidental or consequential damages arising out of Owners use of Pet Sitter

services, nor will Pet Sitter be liable for any claim by any third party, unless gross negligence or willful

misconduct is proven on the part of the Pet Sitter.

18. Pet Sitter reserves the right to terminate this contract at any time before or during its term if Pet Sitter, in

their sole discretion, determines that Owner’s Pet(s) pose a danger to the health and/or safety of Pet Sitter.

If this occurs Pet Sitter will notify the Owner immediately of the problem and determine whether Owner will

return or if pet(s) will need to be placed in a kennel with all charges to be charged to the Owner.

19. Owner authorizes this signed contract to be valid approval for future services of any purposes provided

by this contract permitting Pet Sitter to accept telephone reservations for service and to enter the premises

without additional signed contracts or written authorization.

20. _______By placing my initial here and signing this contract I acknowledge that I have read the Terms and

Conditions in their entirety. If I have any questions about the above I will telephone the Pet Sitter before the

Pet Sit is to begin for explanation or further clarification.

Pet Owner Print Name _______________________________________ Date__________________

Pet Owner Signature_________________________________________

Pet Sitter Print Name_________________________________________ Date__________________

Pet Sitter Signature___________________________________________

*Pet Sitter Henry Wardwell d/b/a/ South Beach Manor is insured for pet care operations.



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