dog’s profile formcreaturecomfortinn.net/cci/wp-content/uploads/2018/04/... · 2018-04-16 · 3 ....

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1 CLIENT INFORMATION: First Name: _________________________________ Last Name: __________________________________________ Address: ________________________________________________________________________________________ City: ____________________________________ State: ___________________ Zip: __________________________ Home Phone: ____________________________________ Work Phone: ____________________________________ Cell Phone: ______________________________________ Email: _________________________________________ Emergency Contact: Name: _____________________ Relationship: ___________________ Phone Number: _______________________ Please list those whom are authorized to pick up your dog: 1.) Name: ________________________________ Relationship: ___________________________________ 2.) Name: ________________________________ Relationship: ___________________________________ Veterinarian: Clinic Name: ______________________________ Address: _____________________________________________ Telephone Number: _____________________________________________________________________________ How did you hear about us? _______________________________________________________________________ Dog’s Name: ______________________________________ Primary Breed: ________________________________ Weight: __________________________ Color: _______________________ Age/Birthdate: ___________________ Check where appropriate: Male Female Spayed Neutered Unaltered Has your dog ever attended a daycare or boarding facility in the past? Yes No Has your dog even been to a dog park? Yes No Does your dog have a basic understand of commands (sit, stay, down etc.)? Yes No Is your dog housebroken? Yes No Is your dog crate trained? Yes No Creature Comfort Inn 1937 Millner Road PO BOX 8 Strasburg, Virginia 22657 T: (540) 465-3007 F: (540) 465-2216 www.creaturecomfortinn.net PET GUEST INFORMATION DOG’S PROFILE FORM

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Page 1: DOG’S PROFILE FORMcreaturecomfortinn.net/cci/wp-content/uploads/2018/04/... · 2018-04-16 · 3 . Peak/Holiday Periods: • Peak/Holiday periods include Jan 1-3, April 1 to October

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CLIENT INFORMATION:

First Name: _________________________________ Last Name: __________________________________________

Address: ________________________________________________________________________________________

City: ____________________________________ State: ___________________ Zip: __________________________

Home Phone: ____________________________________ Work Phone: ____________________________________

Cell Phone: ______________________________________ Email: _________________________________________

Emergency Contact:

Name: _____________________ Relationship: ___________________ Phone Number: _______________________

Please list those whom are authorized to pick up your dog:

1.) Name: ________________________________ Relationship: ___________________________________

2.) Name: ________________________________ Relationship: ___________________________________ Veterinarian:

Clinic Name: ______________________________ Address: _____________________________________________

Telephone Number: _____________________________________________________________________________

How did you hear about us? _______________________________________________________________________

Dog’s Name: ______________________________________ Primary Breed: ________________________________

Weight: __________________________ Color: _______________________ Age/Birthdate: ___________________

Check where appropriate:

� Male � Female � Spayed � Neutered � Unaltered

Has your dog ever attended a daycare or boarding facility in the past? � Yes � No Has your dog even been to a dog park? � Yes � No Does your dog have a basic understand of commands (sit, stay, down etc.)? � Yes � No Is your dog housebroken? � Yes � No Is your dog crate trained? � Yes � No

Creature Comfort Inn 1937 Millner Road

PO BOX 8 Strasburg, Virginia 22657

T: (540) 465-3007 F: (540) 465-2216

www.creaturecomfortinn.net

PET GUEST INFORMATION

DOG’S PROFILE FORM

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Is your dog currently taking nay medications? � Yes � No

NOTE: IF YOU CHECKED YES, YOU WILL NEED TO FILL OUT AND SIGN A MEDICATION

ADMINISTRATION FORM FOR EACH PET

Has your dog been ill in the last 30 days? � Yes � No

Is your dog displaying any symptoms such as coughing, sneezing, or upset stomach? � Yes � No

Does your dog have any previous or current injuries, physical problems or health concerns, including

allergies? � Yes � No If Yes, Please explain ____________________________________________

Does your dog have any physical restrictions while playing, or sensitive area on the body? � Yes � No

If yes, please explain: ___________________________________________________________________________

Please provide proof of the following vaccinations prior to check-in either via e-mail, fax or in person. Bordetella vaccination must be administered at least 7 days prior to any services at

Creature Comfort Inn; 3 days for a nasal vaccination.

Rabies ______________ DHLPP ______________ Bordetella _______________

Is your dog currently on a flea preventative medication? (Required for all guests) � Yes � No

Name of brand used: __________________________ Date it was last given: ______/_______/_________, if

Creature Comfort Inn finds evidence of ticks or fleas, treatment will be provided at owner’s expense.

Please check all answers that describes your dog’s personality: � Outgoing � Timid � Affectionate � Reserved � Protective � Feisty � Friendly � Obedient � Aggressive � Independent � Playful � Confident � Submissive � Clingy � Gentle

Please check all that describe your dog’s attributes: � Jumper � Biter � Digger � Climbs fences � fears noises � howls � Active Chewer

� Barks excessively � Likes to herd � Low activity level � Medium activity level � High activity level � Toy aggressive � Food aggressive � Separation anxiety � Excessive marking � Excessive mounting � Coprophagia (eats feces) � Other: ________________________________________________________

Creature Comfort Inn 1937 Millner Road

PO BOX 8 Strasburg, Virginia 22657

T: (540) 465-3007 F: (540) 465-2216

www.creaturecomfortinn.net

MEDICAL HISTORY

VACCINATION RECORDS

PERSONALITY

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Has your dog ever bitten a person or another dog? � Yes � No If yes, please explain: ___________________________________________________________________________

Please check all that apply when describing situation where your dog may become unfriendly:

� Grabbing collar � Being removed from furniture � Meeting strangers � Meeting other dogs � Being hugged � Being brushed � Being touched while sleeping � Being touched on the ears � Being touched on the paws � Being touched on the mouth � Being touched on the tail � Being touched on the lower back � Around women � Around men � Around children

� Other: ________________________________________________________________________________

Has your dog displayed any of the following reactions? (Please check all that apply):

� Will bite � May bite � Growls � Snaps � Shows teeth � Trembles � Freezes � Moves away

Your dog plays best with: � No Dogs � Big Dogs � Little Dogs � Older Dogs � Puppies

I, the undersigned, hereby acknowledge and agree that all the information in this application is complete and accurate to the best of my knowledge. I further attest that if I am not the sole owner or representative of the dog subject to this application that my signature is sufficient to enter into this application for and on behalf of any other owner or representative.

Signature of Owner: _________________________________ Date: ___________________________________

Creature Comfort Inn 1937 Millner Road

PO BOX 8 Strasburg, Virginia 22657

T: (540) 465-3007 F: (540) 465-2216

www.creaturecomfortinn.net

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Medication/Supplement Name:

For what condition/ailment is the pet being treated?

Is there a specific way that you give you pet his/her medication/supplement?

Verify type of Medication/supplement and provide the exact count of medication being left at CCI.

� Ointment Count

� Oral Count

� Other (Specify) Count

Is the medication/supplement to be administered “As Needed”?

� Scheduled Daily

� A.M. Dose

� Noon Dose

� P.M. Dose

� As Needed If “As Needed,” please specify maximum daily Dosage/frequency:

Creature Comfort Inn 1937 Millner Road

PO BOX 8 Strasburg, Virginia 22657

T: (540) 465-3007 F: (540) 465-2216

www.creaturecomfortinn.net

MEDICATION/SUPPLEMENT ADMINISTRATION FORM

Client First Name: ____________________________ Last Name: _________________________________

Pet’s Name: ____________________________________________________________________________

I am aware and understand that Creature Comfort Inn employees are not veterinarians. CCI employees are not expected to diagnose or detect illnesses in the pets that are staying at Creature Comfort Inn. I agree to assume all risk associated with administration of medications/supplements by Creature Comfort Inn employees during my pet’s stay.

Client Signature: __________________________________________ Date: _________________________

*Signature also required on page 2*

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� Please check this box and ask us for more Medication/Supplement Administration Forms if needed.

I hereby represent that all information provided on this entire Medication Administration Form is accurate.

Client Signature: ______________________________________________________________________

Medication/Supplement Name:

For what condition/ailment is the pet being treated?

Is there a specific way that you give you pet his/her medication/supplement?

Verify type of Medication/supplement and provide the exact count of medication being left at CCI.

� Ointment Count

� Oral Count

� Other (Specify) Count

Is the medication/supplement to be administered “As Needed”?

� Scheduled Daily

� A.M. Dose

� Noon Dose

� P.M. Dose

� As Needed If “As Needed,” please specify maximum daily Dosage/frequency:

Creature Comfort Inn 1937 Millner Road

PO BOX 8 Strasburg, Virginia 22657

T: (540) 465-3007 F: (540) 465-2216

www.creaturecomfortinn.net

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• Include the exact time the medication was administered and the initials of the person(s)Administering it under AM/Noon/PM

• Mark “NA” in each time slot in which medication was not requested or required.• Pet receiving medications “As Needed” must be evaluated at a minimum of three times

daily (AM/Noon/PM) – confirm that the maximum daily dosage has not been exceeded priorto medicating.

Pets Name:

Run # Check in Date: Check Out Date: Manager Initials:

Employee Initial and Time Medication Rendered

Date Medications/Supp AM Noon PM Notes

Creature Comfort Inn 1937 Millner Road

PO BOX 8 Strasburg, Virginia 22657

T: (540) 465-3007 F: (540) 465-2216

www.creaturecomfortinn.net

Medication/Supplement Administration Calendar ~~~~~~~~~~~~~~~For CCI Staff Use Only ~~~~~~~~~~~~~~~

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Pets Name:

Run # Check in Date: Check Out Date: Manager Initials:

Employee Initial and Time Medication Rendered

Date Medications/Supp AM Noon PM Notes

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Creature Comfort Inn 1937 Millner Road

PO BOX 8 Strasburg, Virginia 22657

T: (540) 465-3007 F: (540) 465-2216

www.creaturecomfortinn.net

RESORT POLICIES

Lobby Hours:

• Boarding is available 365 days a year, however the Lobby isn’t open for pickup or drop-offfor Thanksgiving Day or Christmas Day. Due to the high volume of guests, daycare is notavailable on these dates.

Reservations: • Reservations are required for all Boarding Pet Guests.• Reservations are required for Daycare & Grooming services, at minimum, a phone call prior

to arrival. Reservations allocate priority to available spots.• Confirmed reservations must have the following on file:

1.) Proof of current vaccinations-absolutely no guest, for any service, will be admitted without current vaccines.

2.) Resort Policies form, Cat or Dog profile, and the Boarding Services Agreement. (These forms must be completed and signed prior to accepting guest)

• Failure to have the above on file may result in a canceled reservation, and a cancellationcharge.

• Deposits may be required for long-term reservations.

Cancellations: Please note different policies depending on dates. Cancellations must be made within the time frame listed below or you will be charged in full for

the confirmed services, unless otherwise noted. Non-Peak/Holiday periods:

• Boarding: 2 days or less prior to scheduled arrival date.o Cancellations for boarding made within the 2-day period, or a no show, will be charged

for 50% of the total stay (or $50.00 whichever is greater). A deposit will be requiredfor all future reservations of 50% of the boarding fee.

Peak/Holiday periods: • Boarding: 3 days or less prior to arrival date.

o Cancellations for boarding made within the 3-day period, or a no show, will be chargedthe amount of the entire reservation. A deposit will be required for all futurereservations of 50% of the boarding fee.

Monday-Sunday 9:00-12:00 & 3:00-6:00

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Peak/Holiday Periods:

• Peak/Holiday periods include Jan 1-3, April 1 to October 1, Nov. 20-28, December 18-31

Arrivals: • Arrivals and departures occurring outside of Lobby hours is available, but for the safety of

our staff, is strictly appointment only and may incur fees.

Departures:

• Check-out time for Boarding Guests is 12:00 P.M.;All Pet Guests picked up after 3:00 P.M. will incur a full day boarding.

• Last pickup for all guests is 6:00 P.M. Any Pet Guest picked up after 6:00 P.M. willincur a $50.00 late pickup fee, per guest and prior arrangements MUST be made.

Vaccinations:

• Proof of vaccinations from your pet’s veterinarian are required for all services,including grooming. This includes Cats & Ferrets.

• Bordetella must be administered at least seven (7) days prior to your pet’s arrival. TheBordetella nasal and oral vaccination must be administered at least three (3) days priorto your pet’s arrival.

• All puppies and kittens must be 4 months of age and have completed their full series ofvaccinations.

DOGS Rabies: 1 or 3 year DHLPP: 1 or 3 year Bordetella: every 6 months, or 1 year (depending on vaccination provided)

CATS Rabies: 1 or 3 year FeLV: Optional FVRCP: 1 or 3 year (Ferrets: Rabies 1 year)

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Health:

• Pet Guests must have been in good health for the past 30 days prior to their arrival. Creature Comfort Innperforms health checks on all incoming guests and failure to notify staff of health issues may result in acancelled service and a cancellation charge.

• All Pet Guests must be on a monthly flea and tick preventative. This is for the safety of your pet and otherguests, no exceptions.

• If fleas or ticks are found on any pet, they will be bathed and given a flea treatment at the owner’s expense.• Please discuss any specialized care/attention that your pet my require during their stay so that we can

properly provide the care your pet needs.• Creature Comfort Inn reserves the right to refuse admittance to any pet that requires specialized care. In

these situations, we recommend boarding at a veterinarian.• Any guest that may have been in any type of altercation may be overly aggressive or defensive. If your

pet has recently, or ever, been in a scuffle or fight, please let the staff know so that they can beobservant of all dog behavior.

• Guests over 12 years of age must be cleared to stay prior to boarding.• Guests with 3+ more medication must be cleared prior to boarding. In certain instances, we may

recommend boarding at a vet.

Forms:

• Every Pet Guest must have the following three (3) forms completed prior to their arrival:o Resort Policieso Boarding and Services Agreemento Dog or Cat Profile Form

• To ensure proper care, a Boarding Check-In Form must be completed for every Pet Guest’s overnightstay.

• A Medication/Supplement Administration form must be completed for Pet Guests that requiremedication and/or supplements.

• All forms can be found on our website @ creaturecocmfortinn.net

Daycare:

• All Pet Guests must be at least 4 months of age to participate in Daycare, Boarding or Grooming.• Intact males as well as dogs that do not do well in a pack environment cannon participate in Group Play.• We do not accept females in season for Daycare.

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Personal Pet Belongings:

• Creature Comfort Inn provides bedding and bowls for all pet guests during their stay.• Treats may be brought and will be stored with your pet’s food, rawhides and other chewables will be given

ONLY with supervision.• Creature Comfort Inn is not liable for any flea & tick collars left on at drop off. Dogs tend to play with their

mouths sometimes leading to these collars falling off or being removed.• You are welcome to provide your pet with toys in good condition or beds, blankets, shirts etc., Creature Comfort

Inn will not be responsible for items that are lost, destroyed or ingested by your pet.

Client Name (print): ______________________________________________________________

Pet’s Name: ______________________________________

Pet’s Name: ______________________________________

Pet’s Name: ______________________________________

Pet’s Name: ______________________________________

Pet’s Name: ______________________________________

Pet’s Name: ______________________________________

Circle: Cat / Dog

Circle: Cat / Dog

Circle: Cat / Dog

Circle: Cat / Dog

Circle: Cat / Dog

Circle: Cat / Dog

Client Signature: ___________________________________ Date: _____________________________

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Creature Comfort Inn 1937 Millner Road

PO BOX 8 Strasburg, Virginia 22657

T: (540) 465-3007 F: (540) 465-2216

www.creaturecomfortinn.net

Creature Comfort Inn Boarding & Services Agreement

NOTICE TO THE PET OWNER/GUARDIAN:

In consideration for my pet(s) ________________________ being permitted to be a pet guest at Creature Comfort Inn, by signing this document, I _____________________, Owner/Guardian, make the following representations, certify the accuracy of all information provided to Creature Comfort Inn at any time, and agree to all of the following policies, procedures, terms and conditions stated below in the Creature Comfort Inn Boarding & Services Agreement.

Policies, Procedures, Terms & Conditions

1. Owner/Guardian. I represent that I am the owner and/or authorized guardian of my pet and I am fullyauthorized to enter this agreement.

2. Refusal of Service. I understand Creature Comfort Inn reserves the right to deny admittance to any pet forany reason, at any time.

3. Pet Requirements: I represent that my pet meets all of the following requirements: (1) is four months ofage or older, (2) is current on his/her required vaccinations, (3) is on a monthly flea and tick preventativemedication, (4) has been in good health for the last 30 days prior to check-in, (5) my pet is not aggressiveor toy protective, (6) I have completed the Dog or Cat Profile, (7) my dog will enter and exit CreatureComfort Inn on a leash, and (8) my cat will enter and exit Creature Comfort Inn in a cat carrier.

4. Health. I represent that my pet has not had any contagious illnesses of any kind for 30 days prior to check-in. I am aware and understand that Creature Comfort Inn employees are not veterinarians. CreatureComfort Inn employees cannot diagnose or detect illnesses in pats that are staying at Creature ComfortInn. I agree to assume all risk associated with the administration of medication by Creature Comfort Innduring my pet’s stay. In addition, I acknowledge and am aware that vaccines do not protect against allcontagious illnesses that my affect my pet. I HEREBY AGREE TO INDEMNIFY CREATURE COMFORT INN, IT’SOWNERS, DIRECTORS, OFFICERS, EMPLOYEES AND AGENTS AS A RESULT OF MY FAILURE TO INFORMCREATURE COMFORT INN OF ANY PRE-EXISTING MEDICAL CONDITIONS THAT MY PET MAY HAVE.

5. Fleas & Ticks. I agree that if any fleas or ticks are discovered on my pet during check-in or at any othertime while my pet is receiving services at Creature Comfort Inn, that Creature Comfort Inn my administer aflea bath and flea spot treatment at my expense.

6. Veterinarian Care. I agree to allow Creature Comfort Inn to obtain veterinarian medical treatment for mypet, if, in its sole discretion it appears that, the pet is ill, injured or exhibits any other behavior that wouldreasonably suggest that my pet might need medical treatment. Medical treatment may requiretransportation of my pet to receive care and I hereby authorize such transportation. I grant CreatureComfort Inn full authority to make decisions involving the medical treatment of my pet during its stay atCreature Comfort Inn. I agree that I am fully responsible for the cost of such medical treatment andtransportation, not to exceed $ __________________.

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7. Veterinarian Liability: I release, indemnify, and agree to hold Creature Comfort Inn harmless from any andall manner of damages, claims, loss, liabilities, costs or expenses, causes of actions or suits, whatsoever inlaw or equity, (including, without limitation, attorney’s fees and related costs) arising out of or related tothe services provided by Creature Comfort Inn, except which may arise from the sole gross negligence orintentional and willful misconduct of Creature Comfort Inn, including, without limitation, (i) any inaccuracyin any statement made by yourself or information provided by you to Creature Comfort Inn, (ii) your pet,including but not limited to destruction of property, dog bites, injury, and transmission of disease, and (iii)any action by yourself which is in breach of the terms and conditions of this agreement.

8. Transportation. I agree that if my pet is transported to or from Creature Comfort Inn by its employees oragents that I AGREE TO HOLD CREATURE COMFORT INN, ITS OWNERS, DIRECTORS, OFFICERS, EMPLOYEES,OR AGENTS HARMLESS IN THE EVENT OF INJURY OR ACCIDENT DURING TRANSPORTATION.

9. Aggressive Dogs. I certify that my dog is not aggressive and I understand that aggressive dogs are notpermitted to participate in some services at Creature Comfort Inn (unless previously discussed with thetrainer). If my dog acts aggressively or exhibits unacceptable behavior, he/she may be separated fromother dogs. I authorize Creature Comfort Inn to utilize the tools necessary to control my pet for theprotection of other pet guests and humans.

10. Abandonment Notice. I fully understand and agree that if my pet is not picked up by myself or anauthorized representative within 14 calendar days after the day my pet is scheduled to depart, that my petshall be deemed “abandoned” in accordance with Virginia Civil Code 3.2-6504. I understand that ifabandon my pet at Creature Comfort Inn, Creature Comfort Inn, in its sole discretion, will try to re-homemy pet, or relinquish my pet to a legal shelter of its choice. I FULLY UNDERSTAND AND AGREE THAT IF IABANDON MY PET AT CREATURE COMFORT INN, I MAY BE UNABLE TO RETRIEVE MY PET AND WILL HAVENO RECOURSE AGAINST CREATURE COMFORT INN. In addition, I understand that I will still be responsiblefor the unpaid charges incurred for my pet’s stay.

11. Photo and Video Release. I agree to allow Creature Comfort Inn to use my pet’s name and any images orvideos taken while he/she is in the care of Creature Comfort Inn, in any form or format, for use, at anytime, in any media, marketing, advertising, illustration, trade or promotional materials.

12. Personal Property. I agree that Creature Comfort Inn shall not be responsible or liable for any lost, stolen,or damaged personal property belonging to either my dog or me. I also understand and agree that mydog’s collar will be removed in the facility to prevent injury.

13. Service Fees. I agree to pay for all fees, services, and products with a credit card, cash, or check at the timeof my pet’s pickup from each visit at Creature Comfort Inn. I further agree to pay the cost of any check ordebit charges returned or challenged for any reason.

14. Reservations. I understand that confirmed reservations are required for boarding services at CreatureComfort Inn. You will receive a confirmation e-mail when the reservation is made. It is the pet owner’sresponsibility to update email addresses as needed. Without a confirmed reservation (or copy of youremail confirmation if requested) we have the right to refuse your pet if we have no vacancy.

15. Cancellations. Non-holiday/non-peak policy: I understand that all confirmed reservations for NON-HOLIDAY/NON-PEAK DAYS must be cancelled at least (2) days prior to my pet’s reserved arrival date. Ifurther understand that a cancellation made within (2) days of my pet’s arrival date or a no-show willresult in my being responsible for a charge of (2) night stay. In addition, I will be required to pay a depositfor any future reservations of 50% of my pet’s boarding fee.Holiday/Peak policy: I understand that all confirmed reservations for HOLIDAY/PEAK DAYS must becancelled at least (3) days prior to my pet’s arrival date. I further understand that cancellation made within(3) days of my pet’s reserved arrival date, or a no-show, will result in my being responsible for the fullamount of the boarding fee. In addition, I will be required to pay a deposit for any future reservations of50% of my pet’s boarding fee.

Creature Comfort Inn 1937 Millner Road

PO BOX 8 Strasburg, Virginia 22657

T: (540) 465-3007 F: (540) 465-2216

www.creaturecomfortinn.net

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*I hereby understand that these claims are subject to change without notice. CheckCreaturecomfortinn.net for the most current agreements, or contact our office.

Signature of Owner/Guardian: _______________________________________________

Date: ______________________________

16. Check-in & Check-out Times: I understand that the hours for check-in & check-out are (9:00 A.M.-12:00P.M.) & (3:00 P.M. -6:00 P.M.) and check-ins or check-outs outside of those times will incur a $50.00 fee. Ialso understand that if I pick up before noon I am not charged boarding for that day, if however, I pick up3-6 P.M I will be charged for that day of boarding at the normal rate.

17. Resort Policies. I acknowledge that I have received, reviewed and signed a copy of Creature Comfort Inn’s“Resort Policies.” I HEREBY AGREE TO BE FULLY BOUND BY ALL THE TERMS AND CONDITIONS OF CreatureComfort Inn’s “RESORT POLICIES.”

18. Duty to Disclose. I represent the I have disclosed and shall continue to disclose, any and all medicalconditions and any other conditions, including, but not limited to, personality concerns or behaviors thatmay affect, limit, or prevent my pet’s ability to participate in services provided by Creature Comfort Inn. Iunderstand that Creature Comfort inn is relying on and will rely on those representations to provide asafe environment for humans and animals.

19. Controversy or Claim. I agree that any controversy or claim arising out of, or relating to this contract, orbreech thereof, or as a result of any claim or controversy including the alleged negligence by any party tothis contract, shall be settled in arbitration in accordance with the rules of the American ArbitrationAssociation, I further agree that judgment upon award rendered by an arbitrator may be entered in anycourt having jurisdiction thereof and the arbitrator shall, as part of his award to the prevailing party, thecost of such arbitrations and reasonable attorney’s fee of the prevailing party.

20. Sole Agreement. This writing represents the sole agreement between Creature Comfort inn and theOwner/Guardian.

21. Affirmation. Each time I bring my pet into Creature Comfort Inn, I am re-affirming the terms of thisagreement, including updated claims, and the truthfulness and accuracy of all the statements I have madein this agreement.

Creature Comfort Inn 1937 Millner Road

PO BOX 8 Strasburg, Virginia 22657

T: (540) 465-3007 F: (540) 465-2216

www.creaturecomfortinn.net

I HAVE READ AND FULLY UNDERSTAND THE TERMS OF THIS AGREEMENT. I HAVE SIGNED THIS AGREEMENT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE AND INTENT IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO CREATURE COMFORT INN, IT’S OWNERS, OFFICERS, EMPLOYEES AND AGENTS TO THE GREATEST EXTENT PERMITTED BY LAW. I FURTHER AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS TO BE HELD INVALID OR UNENFORCEABLE, THE REMAINDER OF THIS AGREEMNT SHALL REMAIN IN FULL FORCE AND EFFECT.

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CLIENT INFORMATION:

First Name: _________________________________ Last Name: __________________________________________

Address: ________________________________________________________________________________________

City: ____________________________________ State: ___________________ Zip: __________________________

Home Phone: ____________________________________ Work Phone: ____________________________________

Cell Phone: ______________________________________ Email: _________________________________________

Emergency Contact:

Name: _____________________ Relationship: ___________________ Phone Number: _______________________

Please list those whom are authorized to pick up your cat:

1.) Name: ________________________________ Relationship: ___________________________________

2.) Name: ________________________________ Relationship: ___________________________________

Veterinarian:

Clinic Name: ______________________________ Address: _____________________________________________

Telephone Number: _____________________________________________________________________________

How did you hear about us? _______________________________________________________________________

Cat’s Name: ______________________________________ Primary Breed: ________________________________

Weight: __________________________ Color: _______________________ Age/Birthdate: ___________________

Check where appropriate:

� Male � Female � Spayed � Neutered � Unaltered

Is your cat litterbox trained? � Yes � No

Creature Comfort Inn 1937 Millner Road

PO BOX 8 Strasburg, Virginia 22657

T: (540) 465-3007 F: (540) 465-2216

www.creaturecomfortinn.net

PET GUEST INFORMATION

CAT’S PROFILE FORM

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Is your cat currently taking nay medications? � Yes � No NOTE: IF YOU CHECKED YES, YOU WILL NEED TO FILL OUT AND SIGN A MEDICATION ADMINISTRATION FORM

FOR EACH PET Has your cat been ill in the last 30 days? � Yes � No

Is your cat displaying any symptoms such as coughing, sneezing, or upset stomach? � Yes � No Does your cat have any previous or current injuries, physical problems or health concerns, including allergies? � Yes � No If Yes, Please explain ____________________________________________ Does your cat have any physical restrictions while playing, or sensitive area on the body? � Yes � No If yes, please explain: ___________________________________________________________________________

Please provide proof of the following vaccinations prior to check-in either via e-mail, fax or in person.

Rabies ______________ FVRCP ______________ FELV _______________ Is your cat currently on a flea preventative medication? (Required for all guests) � Yes � No Name of brand used: __________________________ Date it was last given: ______/_______/_________, if Creature Comfort Inn finds evidence of ticks or fleas, treatment will be provided at owner’s expense

Please check all answers that describes your cat’s personality: � Outgoing � Timid � Affectionate � Reserved � Independent � Feisty � Friendly

� Playful � Confident � Submissive � Clingy � Gentle Other: _______________________________

Please check all that describe your cat’s attributes: � Likes to scratch � fears noises � howls � Verbally sensitive � Separation anxiety

� Meow’s excessively � Low activity level � Medium activity level � High activity level Other: _____________

I, the undersigned, hereby acknowledge and agree that all the information in this application is complete and accurate to the best of my knowledge. I further attest that if I am not the sole owner

or representative of the cat subject to this application that my signature is sufficient to enter into this application for and on behalf of any other owner or representative.

Signature of Owner: _________________________________ Date: __________________________________

Creature Comfort Inn 1937 Millner Road

PO BOX 8 Strasburg, Virginia 22657

T: (540) 465-3007 F: (540) 465-2216

www.creaturecomfortinn.net

MEDICAL HISTORY

VACCINATION RECORDS

PERSONALITY