1 of 2

Dog Walking Booking Form

Please complete all details in BLOCK CAPITALS

Dog’s Name

Owner’s Details

Name _____________________________________________________________________

Address _____________________________________________________________________

____________________________________ Postcode ___________________

Daytime Number _____________________________________________________________________

Mobile Number _____________________________________________________________________

Evening Number _____________________________________________________________________

Email address _____________________________________________________________________

Dog’s Details

Breed ________________________________________ Gender: Dog Bitch

Size Small Medium Large Extra Large

Colour ___________________________ Date of Birth: _____________ Age: _____

Inoculation Date ___________________________ Micro Chipped: Yes No

Allergies ___________________________ Neutered/Spayed Yes No

Emergency Contact Details (please provide at least two numbers)

Contact One _____________________________________________________________________

Contact Two _____________________________________________________________________

Veterinary Surgeon

Name of Practice _____________________________________________________________________

Address _____________________________________________________________________

Telephone Number _____________________________________________________________________

Further Details

Does your dog pull excessively on the lead? Yes No

Does your dog react aggressively, nervously, or in a negative way to any of the following?

Other dogs Yes No Small animals Yes No

Traffic Yes No People/children Yes No

Horses Yes No Joggers/cyclists Yes No

Livestock Yes No Loud noises Yes No

Please state any notable/adverse reactions related to the above question

_______________________________________________________________________________________

______________________________________________________________________________________

Please indicate if your dog has any issues with dominance or possessiveness over toys/food/people/other dogs?

_______________________________________________________________________________________

_______________________________________________________________________________________

Does your dog have any problems travelling in a car? Yes No

If Yes please give details (overleaf) of how they are used to travelling e.g. cage/boot/with seatbelt harness.

2 of 2

_______________________________________________________________________________________

_______________________________________________________________________________________

Will your dog come back immediately if called: Yes No

Please provide details of any special re-call word or sign your do understands (e.g. clapping, whistling etc.)

_______________________________________________________________________________________

_______________________________________________________________________________________

Are you happy for Faye Lawrence or Ian Humphreys to walk your dog on occasions when I can not?:

Yes No

Insurance Details

Is your dog insured? Yes with ________________________________________ No

Other Details / Further Comments

Please add any further details you may feel relevant

_______________________________________________________________________________________

_______________________________________________________________________________________

Walking Off The Lead

I hereby give authority for Sally Smith to let my dog off the lead, once they are comfortable that my dog knows and trusts them and will return when called. Yes No

Terms and Conditions

• The owner will ensure that their dog is clean, with up-to-date vaccinations, de-flea and anti-worm

treatments. Your dog must wear an identity disc on their collar as it is illegal not to do so.

• The owner undertakes to make full disclosure of any quality or characteristic which might make your dog unsuitable for dog walking, including behavioural or health problems and antisocial behaviour

including aggression. Failure on the part of the owner to disclose any matter, which might render the owner’s dog unsuitable for dog walking, will be deemed a material omission amounting to a fundamental breach of our agreement.

• All efforts will be made to contact the owner in the event of an emergency. However, we reserve the right to make decisions regarding your dog’s health provided it is at all times acting in the best

interests of the dog and on the advice of a veterinary surgeon.

• The owner is responsible for payment of any veterinary fees incurred by us.

• The owner accepts full liability for any loss or damage caused by the dog whilst being walked.

• 24 hours’ notice is required for single cancellations and 1 week’s notice for permanent cancellations.

In the event of notice not being given the full fee will apply for each walk missed.

• For regular users invoices will be issued on a monthly basis. For occasional users invoices will be issued weekly. Payments due must be paid within 7 days of invoice.

• The owner accepts that occasionally circumstances (e.g. illness, holiday or similar) will mean that Sally

Smith will be unable to visit or walk your dog/pet, unless another suitable alternative attendant or walker can be provided.

• Two keys/sets of house keys will be required.

I hereby confirm that I am the owner of the above mentioned dog and that the above details are correct. I further confirm that I will be responsible for all costs incurred either veterinary or other as a result of sickness, accident or damage caused to or by the above mentioned dog, except third party liability. I will ensure that I will notify you of any changes to this information should any become apparent following the submission of this form. I also appreciate that it is my responsibility to update you as and when required.

PRINT NAME __________________________________________________________________________

SIGNATURE ___________________________________ DATE _____________________________

Payment details: Ms S J Smith t/a Doggy Services 4U. Barclay Bank 20-41-12 a/c No. 43664120. Please use bank transfer if possible and add your dog’s name as the transaction reference. Thank you.