Name *

First Name

Last Name

Departure Date *

MM

DD

YYYY

Return Date *

MM

DD

YYYY

Will pet care services be shared with any other people? *

We are no longer able to offer job sharing with competing companies due to liability concerns.

Yes

No

Will other people be authorized to be within the home during the duration of your service range? *

Yes

No

Have you or anyone in your household had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever at or greater than 100 degrees Fahrenheit? *

Yes, we have had symptoms

No, we are symptom free

Have you or anyone in your household been tested for COVID-19 or cared for an individual who is in quarantine or is a presumptive positive or has tested positive for COVID-19? *

Yes

No

To the best of your knowledge have you been in close proximity to any individual who tested positive for COVID-19? *

Yes

No