Pet Grooming Liability Release Waiver

Owner Full Name

First NameMiddle NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Home Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Pet Name

Pet Type / Breed

Pet Age (Years)

Pet Gender

Other

Pet Weight (lbs)

Current Vaccination Status

Known Allergies or Sensitivities

Behavioral Concerns

Preferred Grooming Services

Special Handling Instructions

Emergency Contact Name

First NameLast Name

Emergency Contact Phone

Please enter a valid phone number.Format: (000) 000-0000.

Veterinarian Name

First NameLast Name

Veterinarian Phone

Please enter a valid phone number.Format: (000) 000-0000.

Pet Owner Signature