House and Pet Sitting Registration Form
  1. You can either print, complete and mail this form to us, or complete the information and submit it online.

    All information will be kept completely confidential.

    * is a required field.

  2. PERSONAL INFORMATION
  3. Your Name*
    Please let us know your name.
  4. Your Email*
    Please let us know your email address.
  5. Address
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  6. Place of Employment
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  7. Employers Address
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  8. Home Phone
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  9. Work Phone
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  10. Cell Phone
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  11. Pager
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  12. PET INFORMATION
  13. Nmes of Pets
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  14. Veterinarian Name
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  15. Veterinarian Address
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  16. Veterinarian Phone
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  17. SITTING INFORMATION
  18. How many visits per day
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  19. Food instructions for pets
  20. Where can the food be found
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  21. House care instructions
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  22. Complete directions to the address you would like the service done
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  23. SIGNATURE VERIFICATION
  24. By checking the box below, I verify that all of the information that I've provided is correct. This is my online signature.*
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Professional Sitters Home Health, Inc.
PO Box 3581
Lawrence, KS 66046
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Phone: (785) 842-3301
Fax: (785) 842-3340