Petsitting or Caretaker Authorization Form

Cumberland Animal Hospital

To help us help your pet when they are with a sitter/caretaker, please fill out the form below.

"*" indicates required fields

PETSITTER / CARETAKER AUTHORIZATION

Owner:*

First Last

Pet's Name(s)*

To Whom It May Concern:

I will be leaving my pet(s) with*

Dates*

From when until when

I hereby give my permission to the person(s) listed below to bring my pet(s) to Animal Clinic for any necessary treatment and/or medication in my absence. Cumberland I also give Cumberland Animal Clinic permission to administer any necessary treatments and/or medication to my pet(s) and I will be responsible for any costs accrued.

Owners Signature*

Emergency Phone Number*

Date*

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Name

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