STC Reservation Request

If you are a new client, please be sure to fill out the Short-Term Care Agreement in addition to this request so we can add you to our system. HWAH Short Term Care Agreement – House With a Heart

If you are a current client and there are no updates to the emergency contact, food, or medication, you can email directly with your request stating the date and time of drop off and pick up. Noon to 1pm or 7pm to 8pm.

Your name
First Last
Email*

Name of dog(s)*
Breed*
Weight*
Age*
Special Needs?*
DATE OF DROP OFF*
MM slash DD slash YYYY

TIME OF DROP OFF*
NOON - 1 PM
7 PM - 8 PM
DATE OF PICK UP*
MM slash DD slash YYYY

TIME OF PICK UP*
NOON - 1 PM
7 PM - 8 PM
Emergency contact person during this trip*
First Last
This is a person who would be available to pick up your dog if there is a medical emergency and take to the Vet.
Cell phone number of Emergency contact person.*
FEEDING INSTRUCTIONS (please enter quantities)
MEDICATION INSTRUCTIONS
Comments for this stay
PLEASE NOTE: House with a Heart reserves the right to turn away any dog that is in poor condition at the time of drop off. This includes: Dogs who are in obvious pain, have not been seen by a Vet and do not have medication to keep them comfortable. Dogs who are matted and dirty and in need of grooming.*
I agree
I disagree

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STC Reservation Request

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