Client Informationpage 1 of 2
Owners Name: ______
First Last
Address: ______
Number Street Apartment #
______
Town Province Postal Code
Phone Numbers: Home: ______
Mobile:______
Business: ______Fax______
E-mail ______
Tell us how you heard about Diamond in the Ruff:
Diamond agrees that your personal information will stay confidential and will not be passed on or sold to other companies for solicitation.
Emergency Contact Information
This information is for when you, the owner, cannot be reached for the duration of your pet’s stay. Your emergency contact should always be aware that they are listed and could be required to make critical decisions regarding your pet when contacted.
Name: ______
Phone Numbers: ______
Veterinary Information
Veterinary Clinic Name: ______
Address: ______
Phone Numbers: ______
Page 2
Pet Information
Pet Name: ______
Breed: ______Color:______
Date of Birth______Male Female Fixed Intact
Dog Friendly: Yes No
Allergies, Conditions, Major Surgeries, On-going Medications
Eg. allergic to aloe shampoo, has epilepsy, had hip surgery on right back leg, takes medication in the morning with food for epilepsy, dogs need to be separated for feeding
Feeding Instructions
Use Diamond food Brought our own Food
How many measured cups (NOT scoops) per meal:______
Feeding times (ie. AM, noon, & PM):______
Additional Instructions:______
I, the undersigned owner or authorized agent of the above-described pet/animal acknowledge that I have been advised by Diamond in the Ruff Pet Retreat that all pets receive careful and caring attention while left with them and I also acknowledge and agree that in consideration of them accepting my pet/animal. Diamond in the Ruff Pet Retreat will not be held liable for any damage to the above described pet/animal howsoever arising including loss, injury, sickness or disease, fire, vandalism or any other matter or peril, I fully authorize Diamond in the Ruff pet Retreat to supply and arrange any veterinarian services deemed advisable with respect to the above pet/animal on my behalf and I accept full responsibility for payment of the same. I acknowledge that the Repairers’ and Storers’ Lien Act R.S.O. 1990 shall apply.