BOARDING APPLICATION

Owner Name *

First

Last

YOUR K9'S NAME *

PRIMARY CONTACT NUMBER *

SECONDARY CONTACT NUMBER

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

FULL NAME EMERGENCY CONTACT (other than self) AND RELATIONSHIP *

EMERGENCY CONTACT PHONE *

EMERGENCY CONTACT EMAIL *

WHO HAS AUTHORIZATION TO PICK UP OR VISIT YOUR K9? *

DATE AND ESTIMATE TIME FRAME TO DROP OFF YOUR K9? BETWEEN THE HOURS OF 7 AM AND 7PM *

DATE AND ESTIMATE TIME FRAME TO PICK UP YOUR K9? BETWEEN THE HOURS OF 7 AM AND 7PM *

YOUR K9'S AGE, SEX and WEIGHT *

ALL K9’S MUST BE SPAY OR NEUTERED BY 6 MONTHS OF AGE TO BE ABLE TO BOARD IN OUR SETTING. IS YOUR K9 SPAY OR NEUTERED IF THEY ARE OVER THE AGE OF SIX MONTHS? *

YOUR K9'S BREED AND COLORS/MARKINGS/COAT LENGTH *

WE HAVE A FIVE FOOT HIGH FENCE, SO IF YOUR K9 IS AN ESCAPE ARTIST BY JUMPING FENCES OR DIGGING UNDER FENCES WE WILL NEED TO KNOW THIS. IF YOUR K9 CAN JUMP AND CLEAR A FIVE FOOT FENCE WE WOULD NOT FEEL COMFORTABLE FOR YOUR K9 TO STAY WITH US, AS THEIR SAFETY IS OUR NUMBER ONE CONCERN. PLEASE ELABORATE ON ANY TYPE OF ESCAPE HABITS YOUR K9 MAY HAVE. *

WE HAVE A HOME LIKE SETTING HERE WITH GRASS, GRAVEL, TREES, DIRT AND ALL THE NATRUAL ELEMENTS. WE DO NOT HAVE AN ARTIFICAIL TURF ENVIRONMENT. PLEASE NOTE IF YOUR K9 TENDS TO OBSESSIVELY INGEST ANY OF THESE THINGS THEN THIS MAY NOT BE THE BEST OPTION FOR BOARDING YOUR K9. WE ALSO HAVE TOYS FOR K9'S TO PLAY WITH AS WELL SO IF YOUR K9 HAS A HABIT OF INGESTING BALLS OR ROPE TOYS ETC. WE MAY NOT BE THE BEST OPTION FOR YOUR K9 TO BOARD WITH US. *

PETS HEALTH RECORD REQUIRED PRIOR TO ACCEPTANCE. WHAT IS YOUR VETERINARIAN'S NAME AND CONTACT INFO? *

FLEA AND TICK PREVENTIVES *

HEARTWORM PREVENTIVES? *

ANY MEDICAL RESTRICTIONS WE NEED TO BE AWARE OF, ADDITIONAL MEDICATIONS? PLEASE SPECIFY MEDICATION AND DOSING INSTRUCTIONS *

DOES YOUR K9 HAVE ANY KNOWN ALLERGIES? (FOOD, ENVIRONMENTAL MEDICATIONS ETC) *

WHAT ARE THE FEEDING INSTRUCTIONS FOR FOOD AND TREATS? *

IS YOUR K9 POSSESSIVE OF TOYS? IF SO PLEASE ELABORATE ON THE BEHAVIORS EXPRESSED *

IS IT OK FOR YOUR K9 TO PLAY WITH OTHER K9S? IF NO PLEASE EXPLAIN WHY *

DOES YOUR K9 CURRENTLY SOCIALIZE/PLAY WITH OTHER K9S ON A REGULAR BASIS? *

HOUSE MANNERS: IS YOUR K9 POTTY TRAINED TO GO OUTSIDE OR ON PAD, CRATE TRAINED, ALLOWED ON FURNITURE? *

HAS YOUR K9 EVER BOARDED PREVIOUSLY? IF SO HOW DID THEY DO WITH IT? *

WE USE CRATES FOR ALL K9'S TO SLEEP IN AS WELL AS HAVE THEIR MEALS IN, THIS IS FOR THE SAFETY OF YOUR K9. IS YOUR K9 FAMILIAR WITH BEING CRATED? HOW DO THEY DO WITH THE CRATE? *

HAS YOUR K9 EVER SHOWN ANY AGGRESSION TOWARD OTHER ANIMALS OR PEOPLE? IF YES PLEASE DESCRIBE *

HAS YOUR K9 EVER BITTEN ANOTHER DOG OR PERSON? IF YES PLEASE DESCRIBE *

ANY ADDITIONAL INFO WE SHOULD KNOW ABOUT YOUR K9? *

YOU MUST PROVIDE YOUR K9S FOOD AND TREATS AND MEDICATIONS (MEDICATION WILL REQUIRE INSTRUCTIONS). IF WE SHOULD RUN OUT OF THE SUPPLY PROVIDED FOR FOOD OR TREATS DO WE HAVE PERMISSION TO PURCHASE ADDITIONAL FOR AN ADDITIONAL FEE? *

PLEASE REVIEW OUR VACCINATION POLICY Pawsitively K9 - Wellness/Vaccination Policy - ALL SERVICES We have set high standards here at Pawsitively K9 and we have implemented strict health & safety requirements for a very good reason – we are committed to keeping all pets safe and healthy! If we failed to require protection against contagious diseases and parasites, we could not promise your pet the safest environment possible. Accordingly, all pets visiting must be current on the routine preventative health care for contagious diseases. To insure adequate protection, vaccinations & parasite testing procedures must be provided by a licensed veterinarian (hard-copy documentation required). Thank you in advance for helping us keep all of our PawsitivelyK9 companions healthy and safe! Vaccination Requirements: Pawsitively K9 requires Rabies (Annually or 3 yr). You must present the Rabies certificate-this is what the Rabies tag is usually attached to), DHPP (Distemper, Hepatitis, Parainfluenza, Parvovirus)-Annually, and Bordetella-Annually. For your pets safety and well-being, please allow a minimum of forty eight (48) hours after receiving vaccinations such as Distemper and/or Rabies prior to arrival. PLEASE NOTE: If the Bordetella vaccine has never been given, has expired, or was given via: intranasal (drops in the nose), the vaccine must be administered at least FOURTEEN (14) DAYS PRIOR to arrival. If the Bordetella vaccine is boostered a minimum of FIVE (5) DAYS is required before visiting. PUPPIES are required to have their second set of DHPP, Bordetella vaccinations, and are required to have their Rabies vaccination (at 12-16 weeks of age). We can also vaccinate boosters of Bordetella or DHPP for your K9 in the situation when you are not able to get this from your vet prior to their stay. We will require you to sign a waiver at the time of drop off and can administer the vaccines as soon as they arrive. WE CANNOT ADMINISTER RABIES THIS IS STATE LAW-RABIES MUST BE DONE BY A LICENSED VETERINARIAN. Bottom Line...we want your K9 to be safe healthy and happy. *

TYPE YOUR FULL LEGAL NAME PLEASE

SIGNATURE FOR: VACCINATION POLICY *

Clear Signature

Date / Time *

Date

Time

PLEASE PROVIDE YOUR K9'S VETTING RECORDS HERE. THE RECORDS MUST BE LEGIBLE, HAVE THE VETERINARIAN AND FACILITY NAME AS WELL AS THE K9'S NAME ON THE RECORD. RABIES VACCINES SHOULD BE A RABIES CERTIFICATE. ALL DATES MUST BE LEGIBLE AND MUST SHOW THE DATE OF THE LAST VACCINE (NOT THE NEXT DUE DATE OR REMNDERS) IF YOU WILL BE SUBMITTING A SCREAN SHOT PLEASE USE ADEQUATE BRIGHT LIGHTING AND CROP OUT ANYTHING SURROUNDING YOUR PAPER RECORDS BEFORE SUBMITTING. IF YOU DO NOT ATTACH RECORDS HERE YOU MUST EMAIL A COPY TO PAWSITIVELYK9T@YAHOO.COM IN ADVANCE TO THE DAY OF DROP OFF

Drag & Drop Files, Choose Files to Upload

NO VIDEOS PLEASE ONLY SCREEN SHOTS OR PDF’S OF THE RECORD IN IT’S ENTIRETY.

BOARDING, DAYCARE AND BOARD AND TRAIN SERVICE AGREEMENT/LIABILITY WAIVER 1781 HWY 30 EAST, ATHENS, TN 37303 225-571-6637 1. By signing this Agreement/waiver and leaving your pet with PawsitivelyK9, Owner/Guardian certifies to the accuracy of all information provided to PawsitivelyK9 in writing or orally about the Pet. PawsitivelyK9 reserves the right to deny admittance to the Pet or any pet for any reason at any time. 2. Owner/Guardian specifically represents that he or she is the sole Owner/Guardian of the Pet, free and clear of all liens or encumbrances. 3. Owner/Guardian specifically represents to PawsitivelyK9 that, to Owner/Guardian’s knowledge, the Pet has not been exposed to any contagious diseases within the 30 day period prior to check-in. Owner/Guardian understands that each time Pet is brought to PawsitivelyK9, Owner/Guardian is recertifying that the Pet is in good health and has not had any communicable illness of any kind for 30 days prior to check-in. Owner/Guardian further agrees to provide PawsitivelyK9 with proof of required vaccinations upon request and prior to check-in. Owner has read, understood and agreed to our vaccination policy. In addition, Owner/Guardian agrees that if any fleas or ticks are discovered on the Pet during check-in or at any time during the Pet’s stay, PawsitivelyK9 will administer Frontline Plus topical to the Pet at Owner/Guardians’ expense. 4. While PawsitivelyK9 makes every effort to ensure that pets staying with us are healthy by requiring their Owner/Guardians to affirmatively represent that all vaccines for their pet are current and that they do not believe that their pet has a communicable illness, Owner/Guardian acknowledges and is aware that the employees of PawsitivelyK9 are not veterinarians and do not have backgrounds in animal medicine and are not expected to diagnose or detect illnesses in the pets that are staying at PawsitivelyK9. In addition, Owner/Guardian acknowledges and is aware that vaccines do not protect against all communicable illnesses that may affect a pet 5. OWNER/GUARDIAN ACKNOWLEDGES AND AGREES THAT THEY ARE ASSUMING ALL RISK OF ILLNESS, DISEASE, HARM OR OTHERWISE TO THEIR PET BY ALLOWING THEIR PET TO STAY AT PAWSITIVELYK9. PAWSITIVELYK9 AGREES TO EXERCISE REASONABLE CARE OF THE PET DURING ITS STAY AND, IF APPLICABLE, DURING TRANSPORT. IF A PET IS TRANSPORTED TO OR FROM PAWSITIVELYK9 BY PAWSITIVELYK9 STAFF, OWNER/GUARDIAN HOLDS PAWSITIVELYK9 HARMLESS IN THE EVENT OF INJURY OR ACCIDENT DURING TRANSPORTATION. IT IS EXPRESSLY AGREED BY OWNER/GUARDIAN AND PAWSITIVELYK9 THAT PAWSITIVELYK9's LIABILITY SHALL IN NO EVENT EXCEED THE LESSER OF THE CURRENT CHATTEL VALUE OF A PET OF THE SAME BREED OR THE SUM OF $200.00 PER ANIMAL ADMITTED. 6. Owner/Guardian agrees to be solely responsible for any and all acts or behavior of the Pet while in the care PawsitivelyK9, including payment of costs of injury to self (pet inflicts own injury to self) , staff or other animals or damage to facilities caused by the Pet. Owner/Guardian further agrees to indemnify PawsitivelyK9 and its agents against any claims made against PawsitivelyK9 or its employees or members or other agents or losses or damages of any kind suffered by PawsitivelyK9 or its agents as a result of Owner/Guardian’s failure to inform PawsitivelyK9 of any preexisting condition the Pet may have ( such as illness or aggression problems ) or which were otherwise caused by the Pet. Owner/Guardian understands that a five foot fence is in place and that a K9 prone to climbing or digging to escape should not stay with us. Owner/Guardian understands that the premises do not have an artificial turf, the premises will have grass, trees, plant matter, rocks, gravel and other natural elements that their K9 will be exposed to as well as K9 toys and kiddie swimming pool or sprinkler, if the K9 has previous issues ingesting foreign objects then this environment will not be the best or safest for the K9 and PawsitivelyK9 will not be held responsible for any issues from environmental injury or illness. 7. Owner/Guardian understands that PawsitivelyK9 utilizes playgroups where dogs interact and co-mingle with other pets. Owner/Guardian also understands that squirt water bottles or sound devices may be used to correct unwanted behaviors. If your dog displays aggressive behaviors he or she may be muzzled for their protection or the protection of other dogs or staff. Owner/Guardian agrees that the Pet may be removed from a playgroup at PawsitivelyK9'S discretion and not permitted to interact further with the dogs during current or any subsequent stays. Owner/Guardian further understands that when dogs play in groups that nicks and scratches may occur. PawsitivelyK9 staff may or may not notify Owner/Guardian immediately if the Pet sustains any minor nicks or scratches, PawsitivelyK9 staff may wait and notify Owner/Guardian when the Pet is picked up by or delivered to the Owner/Guardian. IF your pet is seriously injured or falls ill we will do everything we can to contact the owner/guardian immediately. 8. All charges incurred by Owner/Guardian and not previously paid shall be payable upon pickup or delivery of Pet. PawsitivelyK9 shall have, and is hereby granted, a lien on the Pet for any and all unpaid charges resulting from service provided by PawsitivelyK9. The Owner/Guardian hereby agrees that in the event charges are not paid when due in accordance with this contract, PawsitivelyK9 may exercise its lien right within ten days after written notice has been given by PawsitivelyK9 to Owner/Guardian by certified mail to the address shown on the contract. PawsitivelyK9 may dispose of the Pet for any and all unpaid charges, at a private or public sale or surrender to rescue of choice, at the sole discretion of PawsitivelyK9, and Owner/Guardian specifically waives all statutory or legal rights to the contrary. If such sale shall not secure a price adequate to pay such costs of pet care or other charges which are still due and outstanding from the Owner/Guardian, plus costs of sale, then Owner/Guardian shall be liable to PawsitivelyK9 for the difference. All monies realized by PawsitivelyK9 at such sale, over and above the charges due and costs of sale, shall be paid to the Owner/Guardian. 9. Owner/Guardian agrees to pay the pet care service and daily rate in effect on the date Pet is checked into PawsitivelyK9 and to pay for any additional services requested when Owner/Guardian picks up Pet. 10. Owner/Guardian further agrees that the Pet shall not leave the facility until all charges due are paid by Owner/Guardian or proper payment arrangement are agreed upon by both parties. 11. In an emergency PawsitivelyK9 will attempt to contact the Pet’s personal veterinarian as well as the emergency contact provided to PawsitivelyK9 by Owner/Guardian; however, such an emergency might not provide the time to do so prior to the administration of care. Owner/Guardian authorizes PawsitivelyK9 to obtain medical attention for the Pet from any qualified veterinarian and to transport the Pet to and from such veterinarian when PawsitivelyK9 deems such medical care is important to the Pet’s health. Owner/Guardian grants PawsitivelyK9 and its employees or agent full authority to make decisions involving the medical treatment of Pet and agrees to pay for all related costs. This applies to any claims for injuries or damages related to such medical care or that arise due to the transport of the Pet. In the event of a Pet’s death the Owner/Guardian or the Owner/Guardian’s emergency contact will be notified immediately. 12. CANCELLATION POLICY: WE REQUIRE A 24 HOUR NOTICE PRIOR TO CANCELLATION. 13. I hereby grant full permission to PawsitivelyK9 and all of the forgoing, their parent companies, clients, and successors to utilize: photos or videos taken by PawsitivelyK9 of my pet, biography, appearances, name, voice, likeness, and other information I furnish, as well as photos, videos, biography, appearance, name, voice, and likeness of any of my dogs, in connection with PawsitivelyK9 and future promotion of PawsitivelyK9 in any and all manner and form of media. 14. This Agreement contains the entire agreement between the parties. All terms and conditions of this Agreement shall be binding on the heirs, administrators, personal representatives and assignees of the Owner/Guardian and PawsitivelyK9. 15. Any controversy or claim arising out of or relating to this Agreement, or the breach thereof, or as the result of any claim or controversy involving the alleged negligence by any party to this Agreement, shall be settled in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by an arbitrator may be entered in any Court having jurisdiction thereof. The arbitrator shall, as part of the award, determine an award to the prevailing party of the costs of such arbitration and reasonable attorney’s fees of the prevailing party. The arbitrator(s) shall apply Tennessee law to the merits of any dispute or claim, without reference to conflicts of law rules. The parties hereby consent to the personal jurisdiction of the state and federal courts located in Tennessee and agree that such courts shall have the sole and exclusive jurisdiction for any action or proceeding arising from or relating to this Agreement or relating to any arbitration in which the parties are participants. THE PARTIES HAVE READ AND UNDERSTAND THIS CLAUSE 15, WHICH DISCUSSES ARBITRATION. THE PARTIES UNDERSTAND THAT BY SIGNING THIS AGREEMENT THAT THEY WILL SUBMIT ANY CLAIMS ARISING OUT OF, RELATING TO, OR IN CONNECTION WITH THIS AGREEMENT OR THE INTERPRETATION, VALIDITY, CONSTRUCTION, PERFORMANCE, BREACH OR TERMINATION THEREOF, TO BINDING ARBITRATION, AND THAT THIS ARBITRATION CLAUSE CONSTITUTES A WAIVER OF THE PARTY’S RIGHT TO A JURY TRIAL AND RELATED TO THE RESOLUTION OF ALL DISPUTES RELATING TO ALL ASPECTS OF THE RELATIONSHIPS BETWEEN THE PARTIES. *

TYPE YOUR FULL LEGAL NAME PLEASE

SIGNATURE FOR: BOARDING, DAYCARE AND BOARD AND TRAIN SERVICE AGREEMENT/LIABILITY WAIVER *

Clear Signature

Date / Time *

Date

Time

SIGNATURE ACKNOWLEDGMENT TO THE APPLICATION AND ALL TERMS AS STATED IN THE APPLICATION, VACCINATION POLICY AND SERVCE AGREEMENT/LIABILITY WAIVER. TO THE BEST OF MY KNOWLEDGE, THE INFORMATION THAT I HAVE PROVIDED IS BOTH ACCURATE AND TRUE. I ALSO ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND AGREED TO: THE SERVICE AGREEMENT, THE VACCINATION POLICY, LIABILITY WAIVER AND WILL SIGN THIS APPLICATION AS WELL AS THE TRAINING LIABILITY WAIVER AND SERVICE AGREEMENT PRIOR TO MY K9 PARTICIPATING IN ANY TRAINING WITH PAWSITIVELY K9 *

Clear Signature

Date / Time *

Date

Time

Comment

CALL 423-381-0923

PAWSITIVELYK9T@YAHOO.COM