Join – Check My Pets

Page 1 / 6

First Name:

Last Name:

Address:

Address 2:

City:

State:

Zip:

Phone Number:

E-mail:

Create Password:

Repeat Password:

Upload Picture:

Page 2 / 6

Primary Emergency Contact

First Name:

Last Name:

Relationship:

Address:

Address 2:

City:

State:

Zipcode:

E-mail:

Mobile number:

Other number:

Upload a Picture:

Yes, also give them access to my CheckMyPets.com account Information

Yes

No

Yes they have a key to my home or the location of the pets

Yes

No

Location - Time required to respond to your location

Local - within 1-15 minutes

Local - within 15-45 minutes

Not local - more than one hour

Not local - Only available by phone or e-mail

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Second Contact:

First Name:

Last Name:

Relationship:

Address:

Address 2:

City:

State:

ZipCode:

E-mail Address:

Mobile Number:

Other Number:

Upload a picture:

Yes, also give them access to my CheckMyPets.com account Information

Yes

No

Yes they have a key to my home or the location of the pets

Yes

No

Location - Time required to respond to your location

Local - within 1-15 minutes

Local - within 15-45 minutes

Not local - more than one hour

Not local - Only available by phone or e-mail

Page 2 / 6

Third Contact:

First Name:

Last Name:

Relationship:

Address:

Address 2:

City:

State:

ZipCode:

E-mail Address:

Mobile Number:

Other Number:

Upload a picture:

Yes, also give them access to my CheckMyPets.com account Information

Yes

No

Yes they have a key to my home or the location of the pets

Yes

No

Location - Time required to respond to your location

Local - within 1-15 minutes

Local - within 15-45 minutes

Not local - more than one hour

Not local - Only available by phone or e-mail

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YOUR PETS

Pet 1 :

Name:

Type: (dog, cat, etc)

Breed:

Coloring

Temperament in the home:

Temperament with other animals:

Pet’s Age:

Birth Date:

Location of pet when you are away

Crated:

In a room (explain):

Outside:

Other (explain):

Diet

Food Brand:

Amount:

Frequency:

Medical Conditions

Pharmacy (if needed):

Medications taken:

Where located in the home:

Dose (i.e. 50mg):

Frequency (i.e. twice a day, etc):

Other issues or Comments:

Upload a photo:

Page 3 / 6

Pet 2 :

Name:

Type: (dog, cat, etc)

Breed:

Coloring

Temperament in the home:

Temperament with other animals:

Pet’s Age:

Birth Date:

Location of pet when you are away

Crated:

In a room (explain):

Outside:

Other (explain):

Diet

Food Brand:

Amount:

Frequency:

Medical Conditions

Pharmacy (if needed):

Medications taken:

Where located in the home:

Dose (i.e. 50mg):

Frequency (i.e. twice a day, etc):

Other issues or Comments:

Upload a photo:

Page 4 / 6

Veterinarian

Practice Name:

Vet's First Name:

Vet's Last Name:

Address:

Address 2:

City:

State:

Zipcode:

E-Mail Address:

Office Number:

Emergency Phone:

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Legal

I have accommodated my pets in my will

Yes

No

If No, who will you designate as caregiver?

One of your designated contacts

Yes

No

Which One?

Someone Else

Yes

No

Name:

Address:

Address 2:

City:

State:

Zipcode:

E-mail:

Phone:

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