In- Home Services Request

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**As of 1/1/2023 Tri State Pet Care will no longer be offering in-home pet sitting services.**

First Name *

Last Name *

Have you used our service before? *

Yes

No, this is my first time

Were there any issues with your last In Home Pet Care request? *

Yes

Please explain so we can ensure to provide the best possible service. *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number while traveling *

Email Address *

How did you hear about us? *

Do we have a key on file? *

Yes

Coded entry

While traveling you can be reached by: *

phone call

text

other other

List EVERYONE with access to your home and their contact number * 🛈

Name and number of emergency contact while traveling *

Name and number of current vet and preferred emerency vet *

If a pet becomes ill while under the care of Tri-State Pet Care LLC, I authorize the representative of Tri-State Pet Care LLC to transport my pet to my veterinarian (or one who is available) if this is needed in his/her best judgment. I authorize said representative to approve any emergency treatment recommended by the veterinarian (unless otherwise stated in Veterinary Release Form) and I agree to pay promptly for any charges incurred. I release Tri-State Pet Care LLC from any and all liabilities related to transportation, treatment, and expense. *

Yes

Contact before transport

Contact before treatment

I agree to reimburse Tri-State Pet Care LLC for any additional fees for tending to emergency veterinary care as well as any expenses incurred for any other unexpected home, food, or other supply needs. I agree to pay extra fees for visits longer than 30 min in length. I understand that all visits that exceed our base time limit of 30 minutes will be charged additionally $1 per minute and will be billed at the end of your service. The sitter will communicate with you via text/email/ph about visit lengths if it is unexpected. *

Yes, I agree to above terms

Amount of vet care not to exceed $ without contact. *

As a first time Client, I agree to pay in full at the time of the consultation visit or at the time of reserving service for any given dates. For future service periods I agree to pay the full amount on the first day of service, and additional charges will be mailed in afterwards. I understand that if there is an unpaid balance of over 10 days for pet care, Tri-State Pet Care LLC reserves the right to discontinue caring for my pets until balance is paid in full. There will be 5% per month interest charge on any balance due beyond 10 days of your return. *

Yes, I agree

If I arrive home early I have the right to decide if I wish Tri-State Pet Care LLC to continue to care for my pets or not but I understand that FULL payment is still due as Tri-State Pet Care LLC has reserved this time slot in order to care for pets. *

Yes, I understand

I understand that if my absence must be extended Tri-State Pet Care LLC requires DIRECT confirmation (not a phone message or email) for the unscheduled visits. This is to avoid the possibility of missed messages, which could result in interrupted care of my pets. *

Yes, I understand

LIABILITY: 1. Customer expressly waives and relinquishes any and all claims against Tri-State Pet Care LLC, its employees, and associates, except those proven to be arising from negligence on the part of Tri-State Pet Care LLC. 2. Tri-State Pet Care LLC, company owner, agents, assigns, successors and heirs are not liable and are completely indemnified for any and all liability stemming from the act(s) or failure to act of third parties, whether known or unknown, including but not limited to, friends, neighbors, relatives or other service persons, that shall enter your residence for any purpose while Tri-State Pet Care LLC is caring for your pets. List the names and phone numbers of persons with access and permission to enter your home in the designated area on the following page. 3. It is expressly understood and agreed that Tri-State Pet Care LLC shall not be held responsible for any damage to Client's property, or that of others, caused by Client's pet(s) during the period in which the pet(s) are in the care of Tri-State Pet Care LLC. I also agree that it is my responsibility to notify Tri-State Pet Care LLC of any pet(s) that has ever caused an injury to any human or other pet. 4. If a pet has a history of biting or other aggressive behavior, Tri-State Pet Care LLC reserves the right to refuse service. Bites must be reported to the local authorities as provided by law. The owner will be liable for the representatives medical care expenses and damages that result from an animal bite. 5. I attest to the fact that all licenses and vaccinations required by my state, and City in which I reside and/or the County are current according to law. *

Yes, I agree

Service Area ( all prices are based from our location at 10045 Leetown Rd, Kearneysville WV 25430) We are currently accepting clients for Daily walks, Potty breaks, Cats visits in all service areas. *

First date of service * +

Number of visits on first day *

Number of visits on days inbetween *

Date of last day of service * +

Number of visits on last day *

Name, age and type of each pet *

Tasks to be done on each visit

Feeding Instructions Please be specific including amount, and how often, if only once per day please specify am/pm : *

Please describe if you pet is on Medication, be details time of day and what the medication is for *

I confirm that all pets are current with rabies vaccinations (this is required for all pets in our care) *

yes

Please provide any other important information that we may need to know in caring for your pet(s). *

If we need to send a new sitter: *

Have current sitter show them the routine

Have current sitter show them visit, and still schedule meet and greet but not required before visits

Must have meet and greet before new sitter does visits

You will receive a confirmation invoice within 48 hours once you have been added to the schedule. Payment is due on the first visit. If any visit exceeds 30 minutes, you will be notified and additional charges will apply. You are required to confirm all trips and returns for the safety of your pets. Please make sure you fill out a Trip Advisor Form (see our Forms page) every time and leave for your sitter. Also please update any contact information on the Trip Advisor Form if needed. By submitting this form, you are agreeing to the terms above. If your trip is within 48 hours, please call our main office as well at 304-725-7336.