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.
Dogs Name
Dog Name (2)
Authorized Person(s)
Phone(s):
Owner/Guardian Name(s)
Date:
Special Notes
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