Pet History Questionnaire
THIS FORM IS FOR PET SITTING OR DOG WALKING SERVICES ONLY!
Date:
 Client (human) Name:
Address (Street, City):

Home / Cell Phone:

Email Address:
Pet Information:

Total number of pets:
Do your pets get along?
Please fill out one line below for each animal. If you have more than five animals, please submit two questionnaires
Animal                Name                Breed                Color/Markings        Sex        Neutered/Spayed        Age
Do your animals have any history of aggressive behavior with any of the following?
Please fill out one line for each animal if applicable and check all that apply:
Animal's  Name          Food/Toys/Possessions      Dogs     Other Animals (specify)                      People      Children
Do your animals have any phobias? Please check all that apply and indicate below current medication?
Animal's  Name         Separation Anxiety      Thunderstorms         Loud Noises         Strangers      Other (specify)
Animal's name, medication, and dosage instructions.
                      What are your pets daily routines?
Animal's  Name       Brand of Diet        Meals per day        Potty breaks per day         Exercise Routine            Other
Medical Information:
Vet Phone:
Veterinarian Name:

Are your pets current
on all vaccinations?
Please list any names and phone numbers of anyone else who will have access to your home:
Please give any other pertinent information or comments we may need!
Have you ever used a professional pet service before? Please explain.
How did you hear about Go Play?
What days/dates do you need our
services?
By clicking submit I agree all the information provided is accurate. I also agree to complete the
service agreement below. I understand my form will only be kept for 30 days on file.
1046 Massachusetts Ave, Arlington, MA 02476
(781) 325-6088 - jenhgoplay@yahoo.com
Pet Owner's Name:
Home Phone / Cell Phone:
Address:
City / State / Zip:
Emergency Contact Name & Telephone Number:
Veterinarian Name & Telephone Number:
Pet's Name:
 Age:
 Breed:
 Sex:
How did you hear about Go Play?
Has your pet ever bitten or snapped before?
 Yes
 No
If so, what were the circumstances?
Terms & Conditions:
Go Play (hereafter referred to as company), is entrusted to use best judgment in caring for Client’s animal(s). If in the event of emergency, inclement weather,
natural disaster, or other circumstances beyond all control prohibit Company or representative from caring for animal(s), Company will be held harmless for related
consequences.
Company will attempt to assign a qualified person (hereafter referred to as representative) to represent Company and render services in the event of personal
emergency or illness. Client will be notified immediately in such case.
Company will not be responsible for any liability with the animal(s) listed in this agreement. Client is responsible for any deaths, injury to persons, animals or
property, or death or injury to other animal caused by the within named animal(s) in the agreement of this contract.  All claims against Company or representative
will be waived.
Client agrees to pay any veterinary costs to animal(s) during time animal(s) are in the care of the Company. If animal(s) become ill or state of health requires
professional attention, the Company in its sole discretion may engage the services of a veterinarian or administer medicine or give other requisite attention to animal
(s).
All animals must be currently vaccinated. If Company or representative is bitten, injured, or exposed to any disease or ailment received from Client’s animal(s) it is
the Client’s responsibility to pay all costs and damages incurred.
Company agrees to use Client’s equipment for animal(s) and is not responsible for faulty, unsafe, damaged, or any damages too equipment. If Company uses it’s
equipment for animal(s), Client agrees to pay equipment fees.
Client understands pet grooming includes the use of sharp tools and clippers. Client understands the difficulty of using tools on an animal and releases Company of
all fault if animal(s) are injured. Client understands the severity and pain associated with a matted coat and authorizes Company to shave animal(s) if necessary.
Client understands there is a risk of clipper/brush burn, and eye, ear, and skin irritation due to grooming and releases Company of fault.
Company will give an estimate of time(s) for services to be rendered. Client understands this time frame is an estimate only and may vary due to unforeseen
circumstances.
There will be an additional charge for animal(s) who cannot be handled by one person.
Company has the right to refuse service to animal(s) who are overdue on vaccinations, aggressive, barking or acting as a disruption, emotionally stressed, or
unsafe to handle.
Company accepts cash, checks, credit cards, and money orders for payment upon completion of services. If any circumstances arise, leading to additional charges
upon an agreed price, Client is responsible for additional charges.
A 10% late fee applies to all charges not paid within 7 days of completion of services. Monthly invoices are due by the 7th day of the invoice’s next calendar month.
A handling fee of $25.00 will be charged for returned checks. In the event it is necessary to initiate collection proceedings on an account, Client will be responsible
for all attorney fees, court fees, and any other costs of collection.
Client will be given a 15-minute grace period after-hours to pick up animal(s) before incurring a $10.00 late fee.
Dog walks will be completed anytime between 11:00am - 4:00pm daily. Schedule requests can be considered, but not promised.
Company has 1/2 time slot only available for daily dog walks. Please be courteous of our time and other clients.
Pet Shuttle Service will be completed between 7:15am - 8:30am, 12:30 - 2:00pm, and 5:00pm - 6:15pm. Company has shuttle running and is on a tight schedule -
please make sure your pet has been fed and gone to the bathroom before we arrive. If your pet is excessively dirty, foul-smelling, or has an accident in our shuttle,
a $10.00 cleaning charge will be applied.
CANCELLATION POLICY: All cancellations must be confirmed by company by either email or phone. If your cancellation is not confirmed you will be charged.
Dog Walking: You must cancel your same-day dog walk by 10am or you will be billed in full for the walk.
Pet Sitting: You must cancel your visit at least 2 hours prior to your scheduled visit or you will be billed in full for the visit.
Shuttle Pick-up & Drop-off Service:
For morning shuttle services you must cancel by 7:00am or you will be billed in full for the service.
For mid-day services you must cancel by 12:00pm or you will be billed in full for the service.
For evening shuttle services you must cancel by 4:00pm of you will be billed in full for the service.
HOLIDAY POLICY:
On major holidays (New Year's Day, Easter, Memorial Day, Independence Day, Labor Day, Thanksgiving, and Christmas) we will plan on NOT seeing your pet
unless previously scheduled. Minor holidays we will plan on seeing your pet unless previously scheduled.
It is your responsibility to provide us with all changes in schedule due to the holidays. We need all holiday schedules submitted one week prior to the holiday.
PAYMENT POLICY: Payment requests will be considered, but not promised.
If you pay weekly for services, your payment is due the last day of the week we will see your pet.
If you pay monthly for services, your payment is due the last day of the month we will see your pet.
All grooming, class registration, and products (food, toys, etc.) must be paid for at time of purchase.
If you have not been put of a payment schedule and would like to do so, please ask Company for more details. Only certain circumstances allow the availability of
a payment schedule.
SERVICE AREA: Company's service area includes Arlington, Belmont, Medford, Lexington, and Winchester. Clients outside of regularly serviced area may be
assigned a travel charge. We will notify you if a travel charge applies when you reserve visits for your pet(s).
CLASS CREDITS: Class registration is non-refundable. If you miss a class during your paid session, you have a credit to make up the class. This credit must be
used during the next session of class or it will be void.

This contract is binding for initial service agreed upon as well as any subsequent services. This contract is binding for client's current
animals and future animals. All animals in client's care are covered by this contract.
By signing this contract, Client agrees all important information of animal(s) has been released to Company.
I have reviewed this service agreement and agree to the contents of this form.
Client Name:
 Date:
By submitting this form, I agree to the contents of this agreement. I also have submitted the pet history      
   questionnaire form above. Please print out a copy for your records. I understand my form will be kept for
30 days on file. I understand that I need to provide Go Play! with two copies of my house key.
By checking this box, I state that I have read, agree with, and understand all of Go Play's! policies,
including our cancellation policy, inclement weather policy, and our vaccination policy. I will NOT
bring my pet to Go Play's facility for any reason within 7 days of it receiving a rabies, distemper,
parvo, or kennel cough vaccination. I understand that Go Play! has the right to dismiss my pet if I
violate any of these policies. I understand my payment is due upon completion of services.
Go Play! Service Agreement