Ownership Declaration Form

Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Pet's Name

Breed

Age

Sex

MaleFemaleUnknown

Is the pet desexed?

YesNoOther

Is the pet microchipped?

YesNoOther

Do you currently have a veterinarian?

YesNo

Veterinarian Name

First NameLast Name

Clinic Name

Is your pet insured?

YesNo

Insurer's Name

By signing this form, you consent to the following statements:

I, hereby declare that I am the legal owner of the pet given its name above, and give my consent for my pet to participate in any and all activities conducted by this service, hereafter referred to as the "Host".
I understand that the Host may need to take photographs or video recordings of my pet for promotional or other purposes. I grant permission to the Host to take and use any such photographs or video recordings of my pet without compensation to me or any other individual.
I understand that my pet will be under my control and supervision at all times while participating in any activity hosted by the Host. I agree to assume all risks associated with the activity, and to hold the Host harmless from any and all claims, damages, and liabilities arising from my participation or the participation of my pet.
I certify that my pet is current on all required vaccinations and has not been exposed to any communicable diseases or parasites within the past thirty (30) days. I understand that the Host may require proof of vaccination and/or a veterinary certificate of health prior to participation in any activity.
I certify that I have read and understand the terms and conditions of this declaration consent form and that I agree to abide by them.

Date

Signature

Owner Information