Owner Information

Owner’s Name: *

Email *

Contact (Name & Phone):

Home Address:

Home Access instructions ( Gate Code, Door Code, Etc) *

Services Requested

Check-Ins
Overnight Care
Transportation

During time of care what would you like to be completed? Select all that apply: *

Walks
Feed
Medication Administration
Potty Break
Play Time
Custom

If custom, please specify:

Additional Notes:

Pet Information

Pet 1

Name

Breed:

Special Notes / Needs:

Pet Temperament (check all that apply):

Pet 2

Name

Breed

Special Notes / Needs:

Pet Temperament (check all that apply):

Pet 3

Name

Breed

Special Notes / Needs:

Pet Temperament (check all that apply):

Pet 4

Name

Breed

Special Notes / Needs:

Pet Temperament (check all that apply):

Veterinary Information

Veterinarian Name/Clinic

Phone Number:

Address:

Required Vaccinations (Proof Required Before Transport):

Rabies (up-to-date)
Distemper/Parvo (dogs)
Bordetella/Kennel Cough (dogs)
FVRCP (cats)
Other

If selected other (please specify):

Liability & Consent Waiver

I, the undersigned, certify that I am the legal owner/Guardian of the above-named pet(s) and hereby grant permission for Kerbie’s Pet Pick Up & Services to transport my pet(s) as agreed.

I understand and agree that:

1.General Release of Liability

Transport and pet care involve inherent risks. My pet(s) will be handled with care and compassion, but I release and hold harmless Kerbie’s Pet Pick Up & Services from any liability, claims, or damages arising from services provided, except in cases of proven negligence.
Kerbie’s Pet Pick Up & Services, its employees, and affiliates are not liable for injury, illness, escape, or death of any pet during or after transit or at home care.
2. Health, Vaccinations & Pre-Existing ConditionsI am responsible for providing accurate information and ensuring my pet is up-to-date on required vaccinations. Kerbie’s Pet Pick Up & Services is not liable for illnesses due to unvaccinated pets or illnesses that occur naturally or from prior conditions.
I acknowledge that Kerbie’s Pet Pick Up & Services is not responsible for any complications, injuries, stress responses, or health issues arising from my pet’s pre-existing medical or behavioral conditions. This includes, but is not limited to, anxiety, respiratory issues, joint or mobility limitations, allergies, seizures, and age-related conditions. I agree to disclose all relevant health information prior to services and accept full responsibility for any related incidents.
3. Transportation Risks, Delays & Weather ConditionsI acknowledge that delays or schedule changes may occur due to traffic, road conditions, weather, emergencies, or circumstances beyond the company’s control. Kerbie’s Pet Pick Up & Services is not liable for inconveniences, extended transport times, or appointment impacts resulting from such delays. The company will communicate changes as promptly as possible.
I understand that weather can affect my pet’s comfort and safety. Kerbie’s Pet Pick Up & Services will take reasonable steps to keep my pet safe, but is not responsible for health issues caused by extreme heat, cold, humidity, or other weather conditions beyond their control. Services may be delayed, adjusted, or rescheduled if the weather is unsafe.
4. Medical Care, First Aid & EmergenciesKerbie’s Pet Pick Up & Services is not a licensed veterinary provider. Any care, first aid, or decisions made during transport or services are based on best judgment only.
In case of emergency, I authorize the transporter to seek veterinary care at my expense. Kerbie’s Pet Pick Up & Services is not liable for outcomes or complications resulting from medical treatment.
5. At-Home Check-In ResponsibilitiesThe company is not responsible for pre-existing damage, unsecured areas, or issues within the owner’s home that occur outside of the company’s presence or control.
Kerbie’s Pet Pick Up & Services is not liable for malfunctioning keys, lockboxes, garage doors, or entry systems. I agree to provide reliable access to the home.
I am responsible for providing adequate food, supplies, and clear instructions. The company is not liable for issues resulting from incomplete or unclear information.

6. Behavioral Responsibilities & Pet-Caused Damage

I accept full liability for any damage caused by my pet, including but not limited to damage to vehicles, equipment, property, or injury to other animals or individuals. Kerbie’s Pet Pick Up & Services is not responsible for damages or injuries resulting from my pet’s behavior, temperament, or actions.

Kerbie’s Pet Pick Up & Services reserves the right to refuse or discontinue services at any time if a pet’s behavior, the pet’s environment, or interactions with the pet’s owner create an unsafe, unprofessional, or uncomfortable situation.

7.Pricing & Additional Fees

Prices are subject to change at any time and without prior notice. Additional fees may apply for services provided on major holidays, outside of normal business hours, or for before- and after-hours care. All applicable fees will be discussed and agreed upon prior to services being rendered.

8. Photo & Social Media Consent:

I understand and agree that photos and/or videos of my pet may be taken during services. I give permission for these photos and/or videos to be used by Kerbie's Pet Pick Up & Services for promotional and marketing purposes, including but not limited to posting on social media platforms, website content, and other business materials. I understand that my pet’s name or identifying information will not be shared without my permission.

By signing this form, I confirm that I have read, understood, and agree to all terms above.

Owner/Guardian Signature:

Clear

Owner/Guardian Signature:

Date time

Kerbies Pet Pick Up & Services

Owner Information

Pet Information

Veterinary Information

Required Vaccinations (Proof Required Before Transport):

Liability & Consent Waiver

Transportation

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