The Right Steps & Cindy C

The Right Steps ~ Client Profile

Client Name: ___________________________________________________________________________

Address: ______________________________________________________________________________

City: ____________________________Zip Code: _____________ Wk Phone________________________

H Phone _________________________ Mobile Phone / Pager __________________________________

Other_______________________ E-mail Address:__________________________________________

Daily updates? ___Yes ___ No How preferred? ________________________________________

Do you own or rent your home? ___Own ___Rent If renting, landlord’s name and telephone #

(in the event of emergency) _______________________________________________________________

Emergency Contact Relationship Telephone Key ?

______________________________ ______________________ ___________________ __Yes __ No

Does anyone else have access to your property during your absence (housekeeper, gardener, pest

control, relative or friends)? ________________________________________________________________

Location of Main water turn off _____________________________________________________________

Location of electrical panel box _____________________________________________________________

Do you have homeowner / liability insurance that would cover your home in an emergency, or

Injuries caused, in the event of bites, scratches, mauls, etc.? __Yes __No

If yes, who is your carrier and agent? __________________________________________________________

Is there a WEAPON in the house? Y N Which car/truck will be at home? _________________________

Location of pet food / treats / can opener: _______________________________________________________

Location of cleaning supplies extra paper towels: _________________________________________________

Location of the inside and outside trash Inside_____________________ Outside_______________________

Would you like The Right Steps to bring in mail / newspapers? ___Yes ___No - is your mailbox locked? Yes No

If Yes, where is the key? _____________ Box #__________

Adjust lighting __Yes __No Adjust Window coverings __Yes __No Radio/TV __Yes __ No

Water Plants ___Yes ___No __Take garbage out - When_______________________

Do you have a security system ? ____Yes ___ No Advise Company you are using our service.!

Name of Security Service__________________________________________Phone___________________

Entry: ________ Exit Code: _________ Password: __________Location______________________________

Where is the nearest phone? _________________________________________________________________

Miscellaneous Instructions___________________________________________________________________

KEYS: ___ Keep for future visits ___ Return Due to security concerns, The Right Steps will NOT leave keys

locked inside your home. Returned keys will result in a pick up fee for future services of $18.00. No refund

for early return. Payment in full is due prior to service in full via cash or check.

Please notify us upon your return to avoid additional fees for additional visits.

_____________________________________ _________________________

Client Signature Date The Right Steps

This signed document is authorization to enter the above address for the purpose of pet care or home security checks.