1. Please complete this section every visit. Please note that submitting this form does not garantee your reservation. Our staff will confirm all online reservations by email. Owner(s) Name * Pet(s) Name * Arrival * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Check in time * 9:00 - 11:00 a.m. (A.m. check in not available on Sunday) 4:00 - 6:00 p.m. (P.m. check in not available on Saturday) Depart * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Check out time * 9:00 - 11:00 a.m. (A.m. check out not available on Sunday) 4:00 - 6:00 p.m. (P.m. check out not available on Saturday) Emergency contact name/phone no. (someone other than yourself) * Alternate authorized pickup person or emergency contact * Anything we should know about your pet or you: health issues, feeding, fears, phone, email, address Pet's belonging: (Please label; API takes no responsibility for loss) 2. Special Services - Fees in addition to daily rate Treats Knuckle Bone - $8 ea (A favorite for large dogs) Deli Pig Ear - $3.50 ea Happy Hour - Saturday only - Ice-cream & Cookies - $3 Bully Stick - $7-10 ea Rooms Garden Suite - $5/day Kitty Townhouses - $5/day Penthouse Suite - $5/day Cottage Suite - $10/day Bath (Hydro-Surge) Spa Hydro-Surge Bath - $25.00 and up - See note* Medicated, Itch Relief, or Oatmeal Shampoo - Extra $3 (Price based on size & hair type) Special handling - $5/day Puppy, kitten with incomplete inoculations Giant dog breed (120 lbs.+) Physically disabled, needs assistance Behavioral issues Some eye, ear, or other medication application *Price based on dog size and weight. Home Time - $8 ea (# per day) 3. Feeding Feeding House Menu - No charge (Brand: Fromm Gold) *Change in diet may upset your pet's stomach* Own Food - No charge if each meal bagged & labeled ($1 per meal if not bagged) House Specialty Meals - $2 per meal (Green Bean Diet, Can/Dry RD/ID, or Lamb Roll) 4. Medications – Oral, no charge; Injections, $4 each Name How Much How Often Reason Name How Much How Often Reason Name How Much How Often Reason 5. Emergency Medical Care – If we are unable to reach you Veterinary Clinic: Vet: Level of medical attention authorized: measures Yes, take all possible measures. Medical care not to exceed: $ I authorize veterinary care and guarantee payment for all charges incurred. Contact Information Home Phone Work phone Cellphone Email * Home street address City/State/Zip Pet information Breed (or your best guess) Color Age Weight Sex Male Neutered Female Spayed Behavior Dog/Cat ever bitten anyone? Dog - chewer? Dog - Aggressive? Dog – digger/fence jumper? Dog/Cat Chronic Health Problems? I do hereby entrust Alexandria Pet Inn (API) to care for my pet(s) and agree to the terms listed below. Ownership: I am the sole owner of this pet or the owner’s agent, and board this pet with the owner's permission. Payment: All charges incurred are due before this pet is released for departure. I will provide a current credit card number and a one-night deposit. I authorize any unpaid balance to be charged to my card during this pet’s stay or before departure. Special Care: If my pet requires special care, I authorize API to provide that care. I agree to pay all costs for special services rendered. Pet Belongings: I agree that API is not responsible for loss or damage of my pet’s personal belongings. I will provide identification on all belongings left with my pet. Damage and Injury: I agree that I will pay the costs of any and all damage or injuries my pet may cause to people, other animal guests, or the premises. Pet Condition: If my pet has fleas or ticks, is odorous or dirty, I authorize and agree to pay API for bathing and/or CapstarTM upon entry or as needed if my pet becomes soiled. Illness or Injury: If my pet becomes ill or injured, I authorize API, at its sole discretion, to engage the veterinarian of their choice if my regular veterinarian is unavailable. I authorize medical treatment and agree to pay all costs for that care. I authorize my veterinarian to release my pet’s medical and inoculation records to API or any of its agents. I authorize API to administer OTC or prescription medicine, and to give other requisite attention to my pet. Inoculations: My pet’s inoculations are current. (Dogs must have Bordetella.) Safety and Health: I acknowledge that API exercises extreme due diligence in keeping pets safe and healthy, but injury or illness may occur and I hold API harmless. Reservation Changes: I agree to pay for all days reserved, unless I give API 24 hours’ notice of any changes (48 hours for holidays), including dates, late arrivals, and early departures. Minimum Holiday Charge: I agree to pay a 3-night minimum charge during all major holiday weeks. New clients are charged a 3-night nonrefundable deposit. Arrival & Departure Day Charges: I will pay for the date of arrival, regardless of arrival time. I understand that check-out is 11 a.m. I will not be charged for departure day if I pick up my pet before 11 a.m. Weekends: Saturday arrival with Sunday departure = 2-days. Lobby Hours: I will abide by API’s lobby hours. Monday–Friday, 9-11 a.m. and 4-6 p.m.; Saturday 9-11 a.m. only; Sunday CLOSED, with courtesy valet pet pick-up 4:30-5:30 p.m. All Sunday departures are charged for the day. Lobby closes on major holidays and as of 11 a.m. the day before. (Any changes to holiday hours will be posted in advance.) I Agree * I have read and understand this contract and agree to it's terms. Date signed * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Leave this field blank What code is in the image? * Enter the characters shown in the image.