Client Profile and Agreement
This form is for one pet only. If you have more than one pet, please fill out a separate form for each pet.
Email address *
Owner Information: Name *
Your answer
Owner Information: Street Address *
Your answer
Owner Information: City *
Your answer
Owner Information: State *
Your answer
Owner Information: Zip Code *
Your answer
Owner Information: Home Number *
Your answer
Owner Information: Cell Number *
Your answer
Owner Information: Work Phone *
Your answer
Owner Information: Email Address *
Your answer
Emergency Contact (Should not be the same as above): Name *
Your answer
Emergency Contact (Should not be the same as above): Relationship *
Your answer
Emergency Contact (Should not be the same as above): Phone *
Your answer
Emergency Contact (Should not be the same as above): Alt. Phone *
Your answer
Additional Person(s) authorized to pick up pet(s): Name *
Your answer
Additional Person(s) authorized to pick up pet(s): Phone Number *
Your answer
Additional Person(s) authorized to pick up pet(s): Name *
Your answer
Additional Person(s) authorized to pick up pet(s): Phone Number *
Your answer
How did you hear about Tails R Waggin'? (please select one)
If you were referred by an existing customer, please provide their name. We'd love to reward our customer with a free day of daycare:
Your answer
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