RUFFNER’S LUXURY PET BOARDING & DAYCARE
AGREEMENT
1880 Dean Street
St. Charles, IL 60174
630-377-4589
Owners Name(s): ________________________________________________________
Address: _______________________________________________________________
City:______________________________ State:_________________ Zip:___________
Phone:____________________________ Business Phone:_______________________
Cell Phone: _______________________ Email:________________________________
Emergency Contact Name:________________________ Phone:__________________
Name of Pet:_____________________________ Breed:_________________________
Weight:_______________ Color:_________________ Birth Date:________________
Allergies:_______________________ Method of Flea Control:
___________________
CHECK ONE OF THE FOLLOWING:
Neutered Male
Spayed
Female
Is your pet housebroken?
Yes
No
Has your pet ever had kennel cough?
Yes
No
Yes
Does your pet cough, sneeze, wheeze, or exhibit any asthmatic symptoms?
No
Has your pet ever boarded or attended doggie daycare? Yes
No
Has your pet ever bitten a person or another pet? Yes
No
Yes
Has your pet ever exhibited aggressive behavior towards people or other pets?
No
If yes please explain:
________________________________________________________________________
________________________________________________________________________
Has your pet ever been abused, or bitten/attacked by another pet? Yes
No