BOARD & TRAIN APPLICATION

YOUR 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? *

YOUR K9'S INFORMATION: AGE/SEX *

First

Last

YOUR K9'S INFORMATION BREED/COLOR/MARKINGS *

First

Last

HOW LONG HAVE YOU HAD YOUR K9 AND HOW DID YOU AQUIRE? *

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

FLEA AND TICK PREVENTIVES *

HEARTWORM PREVENTIVES? *

WHAT BRANDS OF PREVENTIVES DO YOU USE AND WHEN WAS THE LAST DOSE FOR EACH? *

ANY ADDITIONAL MEDICATIONS? PLEASE SPECIFY MEDICATION AND DOSING INSTRUCTIONS *

DOES YOUR K9 HAVE ANY KNOWN ALLERGIES, MEDICAL ISSUES OR RESTRICTIONS? PLEASE SPECIFY *

WHAT TYPE OF FOOD DO YOU FEED YOUR K9 AND IF WE SHOULD RUN OUT OF THE SUPPLY PROVIDED DO WE HAVE PERMISSION TO PURCHASE ADDITIONAL FOR AN ADDITIONAL FEE?

HOW MUCH FOOD PER FEEDING? HOW MANY TIMES PER DAY? *

ANY FOODS TO AVOID? ANY ALLERGIES? ANY SPECIAL FEEDING INSTRUCITONS? *

DESCRIBE THE EXTENT OF YOUR K9’S TRAINING AND EXERCISE: HOW OFTEN, HOW LONG AND WHAT KIND OF EXERCISE? *

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

ARE THERE ANY SPECIAL GAMES YOUR K9 ENJOYS? *

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

DOES YOUR K9 CURRENTLY SOCIALIZE/PLAY WITH OTHER K9S ON A REGULAR BASIS? IF SO WHERE AND HOW OFTEN? *

PLEASE LIST ALL CURRENT COMMANDS YOUR K9 UNDERSTANDS *

DESCRIBE HOW YOUR K9 REACTS TO GUESTS AND/OR STRANGERS *

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

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

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

HAS YOUR K9 EVER BEEN BITTEN BY ANOTHER K9 OR ANIMAL? IF YES PLEASE DESCRIBE *

DOES YOUR K9 TOLERATE GROOMING POLITLEY? IF NOT PLEASE DESCRIBE *

IF YOU ARE ENROLLING YOUR K9 IN THE BEHAVIOR MODIFICATION PROGRAM WHAT BEHAVIORS DO YOU WANT ADDRESSED?

WHAT METHODS OF TRAINING HAVE YOU IMPLEMENTED WITH YOUR K9 THAT WORKED? *

WHAT METHODS DID NOT WORK? *

HOW DO YOU CURRENTLY CORRECT YOUR K9S UNWANTED BEHAVIORS? *

HOW DO YOU REWARD YOUR K9S DESIRED BEHAVIORS? *

WHAT WOULD YOU SAY YOUR K9'S DAILY HOME LIFE IS LIKE WITH YOU, WHAT ARE YOUR DAILY PATTERNS? *

HAS YOUR K9 EVER BEEN TO OBEDIENCE SCHOOL OR WORKED WITH A PROFESSIONAL TRAINER/BEHAVIORIST? IF SO PLEASE EXPLAIN WHO THE TRIANER WAS, WHAT METHODS THEY UTILIZED AND WHEN THIS WAS DONE. *

DOES YOUR K9 ATTEND REGULAR DOGGIE DAY CARE? DID THE UNWANTED BEHAVIORS HAPPEN AFTER ATTENDANCE? *

DOES YOUR K9 HAVE REGULAR GROOMING APPOINTMENTS? IF SO HAS THEIR BEEN A CHANGE TO THE LOCATION OR A NEW GROOMER? *

ANY ADDITIONAL INFO WE SHOULD KNOW ABOUT THE FAMILY LIFE FOR THE K9? *

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 You can upload up to 10 files.

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

PAWSITIVELY K9 TRAINING LIABILITY WAIVER PLEASE READ CAREFULLY AND SIGN TO ACKNOWLEDGE UNDERSTANDING AND ACCEPTANCE I hereby acknowledge that I have voluntarily applied to participate in or enroll my K9(s) to activities with PawsitivelyK9 Dog Training and Behavior Modification. I am aware that there are inherent risks and hazards involved in activities with and around K9's, and I am voluntarily participating in these activities or enlisting my K9(s) into the services offered, with knowledge of potential dangers. I am aware that any K9, regardless of training, handling, or environmental circumstance, is capable of biting or attacking a human or another dog and I expressly acknowledge the risks there in. In order to participate in any of Pawsitivley K9 activities I, being fully informed of such risks and hazards, agree to assume all risks of such occurrences. I hereby waive any and all claims or actions that I or my guardians or representatives may have, from any and all personal injury to myself, my K9, children in my charge, or harm to property or person caused directly or indirectly, through action or inaction of self or others, by actions that might occur in: Boarding, Board and Train, Doggie daycare, Training sessions, Classes, Evaluations and or other activities with PawsitivelyK9 Dog Training and Behavior Modification activities with or without trainer present or engaged. I AGREE TO INDEMNIFY PAWSITIVELYK9 AND ITS EMPLOYEES AND AFFILIATES FROM ANY AND ALL CLAIMS BY MY BUSINESS OR ORGANIZATION PROFIT OR NON-PROFIT, MYSELF, MEMBER OF FAMILY, OR ANY AGENT WHILE WITHIN TRAINING FACILITIES, WITHIN MY HOME PROPERTY, OR IN THE GENERAL PUBLIC AS A RESULT OF ANY ACTION OR INACTION, OF EITHER MY DOG OR ANY ANOTHER. I ALSO AGREE TO ASSUME SOLE RESPONSIBILITY FOR INJURY OR DAMAGE CAUSED BY MYSELF, CHILDREN IN MY CHARGE, OR BY THE K9 I OWN, FOSTER OR HANDLE AND FURTHER AGREE TO INDEMNIFY, DEFEND AND HOLD THE INSTRUCTORS, TRAINERS, ASSISTANTS AND PROPERTY HARMLESS FROM ANY DAMAGE, LOSS, LIABILITY OR EXPENSE, INCLUDING LEGAL COST AND ATTORNEY’S FEES, WHICH RESULT FROM DAMAGE CAUSED BY MYSELF, CHILDREN IN MY CHARGE, OR BY THE K9 I OWN, FOSTER OR HANDLE. I ALSO ASSUME RESPONSIBILITY FOR COST INCURRED FOR DAMAGES TO PERSONS OR PROPERTY FOR MY K9 IF IT ATTACKS OR BITES ANOTHER K9(S) OR PERSON. I have provided current vaccinations on documents from a licensed veterinarian. PawsitivelyK9 may use pictures of me or my dog for publicity or promotional purposes of PawsitivelyK9 without liability or obligation on of any kind to me. *

TYPE YOUR FULL LEGAL NAME PLEASE

SIGNATURE: PAWSITIVELY K9 TRAINING LIABILITY WAIVER *

Clear Signature

Date / Time *

Date

Time

I understand there will be a $500.00 non refundable deposit required in order to schedule and reserve my K9's place for Board and Train. This deposit will go towards the total fee of the board and train and is not an additional fee. By checking this box you understand and agree to the terms of the $500.00 deposit. *

I understand that I must pay the $500.00 desposit to reserve my K9's place for board and train and I understand that this deposit is not refundable.

TO THE BEST OF MY KNOWLEDGE, THE INFORMATION THAT I HAVE PROVIDED IS BOTH ACCURATE AND TRUE. I ALSO ACKNOLEDGE THAT I HAVE READ, UNDERSTAND AND AGREED TO: THE SERVICE AGREEMENT, THE VACCINATION POLICY, LIABILITY WAIVER AND WILL SIGN THIS APPLICTION AS WELL AS THE LIABLILITY WAIVER AND SERVICE AGREEMENT PRIOR TO MY K9 PARTICIPATING IN ANY TRAINING. WITH PAWSITIVELY K9 *

Clear Signature

Date / Time *

Date

Time

Name

CALL 423-381-0923

PAWSITIVELYK9T@YAHOO.COM