To keep your pet happy and healthy please complete this Intake prior to scheduling a meeting.

Okay to provide information in any format you prefer, then send in an email.

Optional to copy or print this questionnaire. Thanks!

Contact Camp Ruthie with questions, or to request a PDF.

 

Camp Ruthie INTAKE

 

Required documents checklist *(proof required prior to making an appointment for interview): _Rabies (cats & dogs)

_Kennel Cough (dogs)

 

About You

Pet(s) how many?________________

Owner’s Name(s) ________________

Cell Phone #s & Home #s ________________

Street address ________________

Email addresses ________________

About Your Pet (s)

Pets Name ________________

Species/Breed ________________

Spayed/Neutered? ________________

Age or DOB ________________

Weight ________________

Rabies Date Given, Date Expires*________________

KCV (Bordatella for Dogs) Date Given, Date Expires*________________

CIV (Canine Influenza Virus Vaccination recommended for boarding option) ________________ Microchip # and Registration (if applicable) ________________

Special issues or Medications? ________________

Indoor pet? ________________

(Owners of more than one pet, complete information for each pet in your household)

Preferred Veterinarian(s) Name and Business ________________

(if not a local vet, please provide contact info.) ________________

Ever boarded, and where? ________________

Usual/Former Petsitter/Dog walker? ________________

 

Do you have 3 emergency contacts? ________________

(An emergency contact is someone who could make decisions and possibly take over care of your pet or property, as well as make payments, on your behalf, should you be unreachable or indisposed. This is for your protection and a way to avoid expensive added services in case of an emergency. Emergencies include natural disasters, illness, etc. Typically clients provide at least 1 neighbor, 1 friend, and 1 relative, not all necessarily local.)

Emergency Contacts (okay to provide later, but required to book a reservation.)

Emergency Guardian 1: Name(s), Relationship, Mobile & Home phone, Address, Email _________ Emergency Contact 2: Names(s) Relationship, Mobile & Home phone, Address, Email __________ Friendly Neighbor(s) Contact 3: Relationship, Mobile & Home phone, Address, Email ___________ Additional designee: Relationship, Mobile & Home phone, Address, Email ___________

 

For Dog Visits, Do you have a fenced yard? ___________

For Dog Boarding, Is your dog Gentle, Socialized, and Crate-able? ___________

 

Any concerns? ___________

*Please note for required proof, it is okay to send a digital photo of current vaccinations.

Or you may contact your veterinarian to authorize them to email records to Camp Ruthie.

 

Contact Camp Ruthie with questions, or to request a PDF.

 

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