Emergency Contact & Phone
Has your dog ever bitten other people/pets?
Does your dog chew - bedding/bowls?
Can your dog jump a 6 foot fence?
Vaccinations (include dates)
Current food brand?
Please list any dietary restrictions.
In case of emergency, or if I am unable to pick up my dogs, I (owner/guardian) authorize A Pampered Pooch Bellevue to release the above referenced dog(s) to the following persons. I understand that no other written authorization from me is required for my dog(s) to be released to one of the persons listed herein. I understand that A Pampered Pooch Bellevue will automatically release my dog(s) to the parties listed on the new client information sheet and who have signed the Pet Release form. I understand that I may revoke any person(s) authorization at any time by completing a new Authorization to Release Dog form.
Dog Name (2)