Pet Sitters Associates, LLC.

Pet/Dog Daycare Questionnaire

Insurance Qualifications:
Maximum number of pets at any one time: 10
Maximum number of pets allowed overnight: 5
You must also belong to Pet Sitters Associates, LLC as a regular member.
Please note that the dog/pet day care coverage only applies to the location listed on the member's certificate of membership.

Please answer the following questions

1) Are all pets checked to be certain they are current on all vaccinations?
   Yes No
     If no, please explain:


2) Do you have a way to separate pets at your daycare in an emergency situation, such as kennels, crates or baby gates?
   Yes No
     If no, please explain:


3) Do you check each pet for individual temperament to confirm that they are socially acceptable with the other pets?
   Yes No
     If no, please explain:


4) Have you ever had an insurance claim involving your Pet Daycare?
   Yes No
     If yes, please explain:

If you meet the Insurance qualifications as outlined above and answered questions 1, 2, and 3 'Yes' and question 4 'No', you are eligible to add Dog or Pet Daycare to your Pet Sitters Associates Membership. The additional charge for this is $165. Please fill out the following information and click 'continue'. After submitting this form, you will be taken to the Membership Application which will need to be printed, signed and mailed to: Pet Sitters Associates, LLC 2924 Northwinds Dr., Eau Claire, WI 54701.

Name:
Address:
City:
State:
Zip:
Phone:	() -

(the answers to this questionnaire will be shown on the application)

If you would prefer, you can download the printable questionnaire and mail it along with the application.

YOU MUST BE A MEMBER OF PET SITTERS ASSOCIATES TO QUALIFY FOR
THIS ADDITIONAL INSURANCE. PSA'S BASIC MEMBERSHIP IS $174
AND REQUIRES A COMPLETED MEMBERSHIP APPLICATION.