Veterinary Release Form

Pet Owner Information:

Full Name(s)

Address

Mobile

Landline (optional)

If insured, name of insurer

Pet Information

Name:

Age:

Description:

Medical conditions/medication

Name:

Age:

Description:

Medical conditions/medication

Name:

Age:

Description:

Medical conditions/medication

Veterinary Practice Information

Name

Address

Telephone Number

Pet Sitter Information

Name of Cat Sitter: Cathy Johnston

Company name: CatStaycation Pet Sitting Service

Mobile: 07761 483706

Address: 15 Jetty Road, Hempsted, Gloucester GL2 5FS

Agreement

I hereby authorise the attending veterinarian to treat any of my pets listed above and I accept full responsibility for all fees and charges incurred in their treatment.
The pet sitter set out on this form is authorised to transport my pets to and from the above veterinary clinic for treatment in the event of an emergency or sickness.
Should this veterinary clinic not be available, I authorise for the transport of any of my pets to an alternative choice or nearest Veterinary Emergency Hospital if it is deemed necessary.
If I cannot be reached, in the case of an emergency, I give the sitter permission to approve treatment up to:

Amount in £

No Limit

I accept terms & conditions above

Client Signature

Date:

Cathy Johnston on behalf of CatStaycation

Date: