Pet Trust Sample Form – Fill Out and Use This PDF

PetGuardian฀Pet฀Trust฀Plan:฀Pet฀Owner฀Application

Congratulations฀for฀making฀this฀important฀effort฀to฀plan฀for฀the฀future฀care,฀support฀and฀love฀of฀your฀pets.฀PetGuardian’s฀goal฀is฀to฀provide฀an฀ affordable฀and฀comprehensive฀solution.฀We฀encourage฀you฀to฀consult฀with฀your฀attorney฀to฀incorporate฀your฀PetGuardian฀Pet฀Trust฀documents฀into฀ any฀existing฀estate฀plans฀in฀addition฀to฀appropriately฀establishing฀a฀separate฀pet฀trust฀fund฀as฀necessary.

After฀you฀have฀completed฀this฀application,฀please฀mail฀to:฀PetGuardian,฀1484฀Pollard฀Rd,฀No.฀444,฀Los฀Gatos,฀CA฀฀95032.฀฀

You฀may฀also฀fax฀the฀application฀to฀us฀at฀408.866.6659.฀Should฀you฀need฀help฀completing฀the฀application,฀you฀can฀find฀suggestions฀on฀our฀ website฀at฀www.petguardian.com.฀You฀can฀easily฀contact฀us฀using฀our฀email฀contact฀form฀located฀on฀our฀website฀or฀send฀us฀an฀email฀at฀ info@petguardian.com.

Please฀fill฀out฀all฀relevant฀sections฀of฀this฀application.฀Print฀clearly฀in฀blue฀or฀black฀ink.

What฀information฀is฀needed฀in฀order฀to฀complete฀the฀application?

The฀following฀is฀an฀abbreviated฀checklist฀that฀outlines฀some฀of฀the฀information฀you฀may฀want฀to฀collect฀prior฀to฀completing฀this฀application.฀ ฀Specific฀information฀about฀your฀pets฀including฀birth฀date฀(year฀is฀mandatory),฀medical฀history,฀special฀needs฀and฀behavioral฀habits

฀Contact฀information฀for฀your฀veterinarian(s)

฀Costs฀associated฀with฀taking฀care฀of฀your฀pets;฀food,฀medications,฀supplies฀and฀yearly฀veterinarian฀costs

฀Contact฀information฀for฀responsible฀individuals฀who฀will฀be฀able฀to฀take฀care฀of฀your฀pets฀temporarily฀or฀permanently฀if฀necessary

฀Contact฀information฀for฀the฀person(s)฀you฀would฀want฀to฀administer฀your฀pet฀trust ฀Details฀outlining฀how฀your฀pets฀should฀be฀taken฀care฀of฀should฀they฀become฀seriously฀ill฀or฀die

Please฀review฀the฀Terms฀of฀Agreement฀on฀the฀last฀page฀of฀this฀application฀and฀provide฀your฀signature฀below.฀This฀is฀required฀in฀order฀to฀process฀ your฀application.฀

1b.฀Second฀Pet฀Owner฀Information฀(optional)

฀฀฀฀-฀1฀-

©2004฀PetGuardian,฀LLC฀฀฀•฀฀฀www.petguardian.com

Breed฀(for฀dogs:฀if฀no฀specific฀breed,฀please฀indicate฀small,฀medium,฀large฀or฀giant)

I.D.฀Marks฀(includes฀microchips,฀tattoos,฀unique฀coloring฀and฀scars)

Medical฀History฀(any฀specific฀information฀relative฀to฀the฀pet’s฀health฀history)

Special฀Needs฀(any฀specific฀requirements฀such฀as฀a฀permanent฀medical฀condition฀or฀special฀exercise฀routine)

Behavioral฀Habits฀(such฀as฀“protective,”฀“fear฀of฀loud฀noises”฀or฀anything฀unique฀about฀your฀pet’s฀behavior)

Where฀is฀your฀pet’s฀medical฀history฀located?

Do฀you฀maintain฀additional฀instructions฀for฀this฀pet?฀฀฀฀Yes฀฀฀฀฀No

If฀yes,฀where?

What฀brand฀of฀food฀do฀you฀feed฀this฀pet?

Approximately฀how฀much฀food฀per฀day?฀(for฀example,฀3฀cups฀twice฀per฀day)

When฀are฀the฀typical฀feeding฀times?

Medications฀and฀supplements

Approximately฀how฀much฀do฀you฀typically฀spend฀yearly฀for฀veterinary฀costs? ฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀$

Approximately฀how฀much฀do฀you฀spend฀each฀month฀for฀food?฀ ฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀$

Approximately฀how฀much฀do฀you฀spend฀each฀month฀for฀medications?฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀$

Approximately฀how฀much฀do฀you฀allocate฀yearly฀for฀bedding,฀toys,฀grooming,฀supplies?฀ ฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀$฀

How฀much฀do฀you฀wish฀to฀allocate฀for฀pet฀health-related฀emergencies฀per฀year?฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀$

฀

฀฀฀฀-฀2฀-

©2004฀PetGuardian,฀LLC฀฀฀•฀฀฀www.petguardian.com

2b.฀Pet฀Health฀Insurance฀Information฀for฀First฀Pet

Do฀you฀currently฀own฀a฀pet฀insurance฀policy?฀฀฀Yes฀฀฀No฀฀

If฀yes,฀please฀provide฀the฀following฀information:฀

3a.฀Information฀for฀Second฀Pet

Pet’s฀Name฀Sex฀(Male/Female)฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀Date฀of฀Birth฀(Month/Year)

Type฀(Indoor฀Cat,฀Outdoor฀Cat,฀Dog,฀Bird,฀or฀Horse)฀

Breed฀(for฀dogs:฀if฀no฀specific฀breed,฀please฀indicate฀small,฀medium,฀large฀or฀giant)

I.D.฀Marks฀(includes฀microchips,฀tattoos,฀unique฀coloring฀and฀scars)

Medical฀History฀(any฀specific฀information฀relative฀to฀the฀pet’s฀health฀history)

Special฀Needs฀(any฀specific฀requirements฀such฀as฀a฀permanent฀medical฀condition฀or฀special฀exercise฀routine)

Behavioral฀Habits฀(such฀as฀“protective,”฀“fear฀of฀loud฀noises”฀or฀anything฀unique฀about฀your฀pet’s฀behavior)

฀฀฀฀-฀3฀-

©2004฀PetGuardian,฀LLC฀฀฀•฀฀฀www.petguardian.com

7.฀Pet฀Sitters฀and฀Boarding฀Facilities฀(optional) Should฀your฀designated฀caregiver฀go฀on฀vacation฀or฀be฀temporarily฀unavailable฀to฀care฀for฀your฀pets,฀who฀do฀you฀want฀to฀take฀care฀of฀them?

Primary฀Pet฀Sitter฀or฀Boarding฀Facility ฀฀฀฀฀฀฀฀฀฀

8.฀Emergency฀Contact฀Information฀(optional) Emergency฀contacts฀might฀include฀friends฀and฀family฀members฀who฀may฀not฀necessarily฀take฀care฀of฀your฀pets฀but฀would฀be฀able฀to฀assist฀in฀case฀ of฀an฀emergency.฀Emergency฀contacts฀should฀be฀different฀than฀designated฀caregivers฀listed฀in฀Section฀6.฀฀

Contact฀#1฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀ ฀

฀฀฀฀-฀6฀-

©2004฀PetGuardian,฀LLC฀฀฀•฀฀฀www.petguardian.com

Terms฀of฀Agreement

By฀creating฀a฀membership฀account฀or฀pet฀trust฀application฀form,฀or฀providing฀any฀information฀to฀PetGuardian,฀I฀agree฀that฀I฀have฀read฀the฀following฀“Terms฀of฀Agreement”฀in฀its฀ entirety฀and฀agree฀to฀be฀bound฀by฀the฀terms฀set฀forth฀below.

1.฀ I฀understand฀and฀agree฀that฀PetGuardian฀is฀not฀a฀law฀firm,฀and฀PetGuardian฀does฀not฀practice฀law฀and฀does฀not฀give฀legal฀advice.฀PetGuardian฀is฀not฀an฀attorney฀and฀the฀ employees฀of฀PetGuardian฀are฀not฀acting฀as฀my฀attorney.฀Rather,฀I฀am฀representing฀myself฀in฀this฀legal฀matter.฀By฀using฀PetGuardian,฀no฀attorney-client฀relationship฀will฀be฀created฀ with฀PetGuardian฀or฀any฀of฀its฀employees,฀and,฀that฀as฀a฀result,฀any฀information฀I฀provide฀to฀PetGuardian฀will฀not฀be฀subject฀to฀the฀attorney-client฀privilege.฀

2.฀ As฀part฀of฀the฀PetGuardian฀plan,฀PetGuardian฀provides฀a฀computerized฀legal฀document฀form.฀I฀understand,฀as฀the฀pet฀owner,฀that฀PetGuardian฀is฀offering฀these฀computerized฀legal฀ document฀preparation฀service฀tools฀in฀order฀to฀create฀my฀own฀pet฀trust฀form฀from฀the฀information฀that฀I฀provide฀and฀therefore฀it฀is฀in฀my฀best฀interests฀to฀provide฀complete฀and฀ accurate฀information.

3.฀ I฀understand฀that฀while฀PetGuardian฀makes฀every฀effort฀to฀maintain฀the฀forms฀it฀provides฀consistent฀with฀current฀U.S.฀state฀laws,฀PetGuardian฀cannot฀guarantee฀that฀the฀forms฀it฀ provides฀comply฀with฀the฀laws฀of฀any฀jurisdiction.฀

4.฀ I฀understand฀that฀PetGuardian฀will฀provide฀me฀with฀a฀draft฀living฀trust฀form฀that฀I฀can฀present฀to฀my฀estate฀planning฀attorney฀for฀review฀and,฀if฀appropriate,฀incorporation฀into฀my฀ estate฀plan฀documents.฀฀I฀understand฀that฀based฀on฀the฀information฀I฀provide฀to฀PetGuardian,฀if฀I฀want฀assurance฀that฀the฀trust฀form฀is฀appropriate฀for฀my฀particular฀situation฀and฀ complies฀with฀the฀laws฀of฀my฀state,฀I฀must฀consult฀with฀my฀local฀estate฀planning฀attorney.฀

5.฀ I฀understand฀that฀PetGuardian’s฀review฀of฀my฀answers฀is฀limited฀to฀completeness,฀spelling฀and฀grammar,฀as฀well฀as฀internal฀consistency฀of฀names,฀addresses฀and฀the฀like.฀I฀ ฀ understand฀that฀I฀am฀solely฀responsible฀for฀the฀finalization฀of฀any฀document(s)฀provided฀by฀PetGuardian.฀

6.฀ I฀understand฀that฀PetGuardian฀may฀from฀time฀to฀time฀provide฀me฀with฀information฀regarding฀third฀parties,฀which฀are฀not฀associated฀with,฀related฀to,฀or฀endorsed฀by฀PetGuardian.฀ I฀understand฀that฀PetGuardian฀has฀not฀verified฀the฀existence฀of,฀has฀not฀assessed฀the฀quality฀of,฀and฀is฀not฀responsible฀for฀any฀services,฀information,฀or฀other฀resources฀provided฀by฀ these฀third฀parties.฀฀I฀further฀understand฀that฀this฀information฀has฀been฀supplied฀only฀for฀the฀purpose฀of฀enabling฀me฀to฀do฀my฀own฀research฀in฀effectuating฀an฀estate฀plan฀for฀my฀ pet,฀and฀as฀such,฀I฀understand฀that฀PetGuardian฀recommends฀that฀I:฀a)฀carefully฀read฀the฀information฀on฀any฀such฀website;฀b)฀directly฀contact฀the฀third฀party;฀c)฀visit฀the฀third฀party’s฀ facilities฀before฀relying฀upon฀any฀service฀or฀resources฀provided;฀and฀d)฀obtain฀and฀ask฀references฀about฀the฀third฀party฀and฀its฀reputation.

7.฀ I฀understand฀and฀agree฀that฀this฀form฀may฀only฀be฀used฀for฀my฀personal฀use฀and฀may฀not฀be฀sold฀or฀redistributed฀without฀the฀written฀consent฀of฀PetGuardian.฀I฀understand฀that฀the฀ use฀of฀this฀form฀is฀solely฀for฀my฀own฀personal฀use฀and฀that฀I฀may฀not฀sell,฀copy,฀distribute,฀display,฀publish,฀or฀republish฀this฀document,฀whether฀for฀free฀or฀fee,฀unless฀I฀or฀the฀person฀ on฀whose฀behalf฀I฀am฀acting฀pay฀for฀each฀such฀document฀or฀package.

8.฀ I฀agree฀that฀California฀law฀shall฀govern฀any฀disputes฀arising฀from฀my฀use฀of฀PetGuardian’s฀products฀or฀services฀or฀its฀website,฀and฀that฀the฀courts฀of฀Santa฀Clara฀County,฀State฀of฀ California,฀shall฀have฀exclusive฀jurisdiction฀over฀any฀such฀disputes.

9.฀ I฀UNDERSTAND฀THAT฀PETGUARDIAN฀ASSUMES฀NO฀LIABILITY฀FOR฀ANY฀FORMS฀OR฀INFORMATION฀PROVIDED฀TO฀ME฀AND฀THAT฀THE฀PETGUARDIAN฀SERVICE฀AND฀ALL฀FORMS฀ AND฀INFORMATION฀PROVIDED฀BY฀OR฀THROUGH฀PETGUARDIAN฀OR฀THROUGH฀USE฀OF฀THE฀PETGUARDIAN฀WEBSITE฀ARE฀PROVIDED฀“AS฀IS”฀WITHOUT฀ANY฀WARRANTY฀OR฀ GUARANTEE฀OF฀ANY฀KIND,฀WHETHER฀EXPRESS฀OR฀IMPLIED฀INCLUDING,฀WITHOUT฀LIMITATION,฀ANY฀IMPLIED฀WARRANTY฀OF฀MERCHANTABILITY฀OR฀FITNESS฀FOR฀A฀PARTICULAR฀ PURPOSE.฀฀I฀UNDERSTAND฀THAT฀FORMS฀SHOULD฀BE฀USED฀STRICTLY฀AS฀A฀GUIDE฀AND฀SHOULD฀BE฀MODIFIED฀BY฀MY฀ATTORNEY฀TO฀MEET฀THE฀LAWS฀OF฀MY฀STATE฀AND฀THAT฀MY฀ USE฀OF฀THESE฀FORMS฀IS฀AT฀MY฀OWN฀RISK.

10.฀ I฀฀UNDERSTAND฀AND฀AGREE฀THAT฀IN฀NO฀EVENT฀WILL฀PETGUARDIAN,฀ITS฀AGENTS,฀PARTNERS,฀฀AFFILIATES,฀SUCCESSORS฀OR฀ASSIGNS฀BE฀RESPONSIBLE฀FOR฀ANY฀DIRECT,฀

INDIRECT,฀INCIDENTAL,฀SPECIAL,฀EXEMPLARY,฀OR฀CONSEQUENTIAL฀DAMAGES฀HOWEVER฀CAUSED฀OR฀ON฀ANY฀THEORY฀OF฀LIABILITY,฀WHETHER฀IN฀CONTRACT,฀STRICT฀LIABILITY,฀ OR฀TORT฀(INCLUDING฀NEGLIGENCE฀OR฀OTHERWISE)฀ARISING฀IN฀ANY฀WAY฀OUT฀OF฀ANY฀ERRORS฀OR฀OMISSIONS฀IN฀THE฀CONTENT฀OF฀ITS฀WEBSITE฀OR฀ANY฀OTHER฀LINKED฀SITES฀

OR฀THE฀USE฀OF฀ITS฀WEBSITE฀OR฀THE฀FORMS฀PROVIDED฀ON฀ITS฀WEBSITE฀OR฀ANY฀INFORMATION฀OR฀FORMS฀OTHERWISE฀PROVIDED฀BY฀PETGUARDIAN,฀EVEN฀IF฀ADVISED฀IN฀ ADVANCE฀OF฀THE฀POSSIBILITY฀OF฀SUCH฀DAMAGE.

11.฀ I฀UNDERSTAND฀AND฀AGREE฀THAT฀IN฀NO฀EVENT฀SHALL฀PETGUARDIAN’S฀OR฀ITS฀AGENTS’,฀PARTNERS’,฀AFFILIATES’,฀SUCCESSORS’฀OR฀ASSIGNS’฀LIABILITY฀FOR฀ANY฀PRODUCT฀OR฀

SERVICE฀PROVIDED฀BY฀OR฀ON฀BEHALF฀OF฀PETGUARDIAN฀EXCEED฀THE฀AMOUNT฀PAID฀FOR฀SUCH฀PRODUCT฀OR฀SERVICE.

12.฀ I฀understand฀that฀PetGuardian฀may฀assign฀this฀Agreement฀and฀any฀information฀I฀have฀provided฀to฀PetGuardian฀in฀connection฀with฀a฀sale,฀merger,฀or฀other฀transfer฀or฀disposition฀of฀ all฀or฀substantially฀all฀of฀the฀assets฀of฀PetGuardian฀or฀its฀affiliated฀entities฀(including,฀without฀limitation,฀in฀connection฀with฀any฀bankruptcy฀or฀similar฀proceedings).

13.฀ I฀understand฀that฀PetGuardian฀will฀not฀provide฀any฀products฀or฀services฀unless฀I฀have฀signed฀the฀Acknowledgement฀of฀Terms.

฀฀฀฀-฀8฀-

©2004฀PetGuardian,฀LLC฀฀฀•฀฀฀www.petguardian.com