PCS Handling Permission Form

A. REGISTRATION INFORMATION ABOUT THE DOG

Breed

Variety/ Color

Sex

Call Name

AKC#

Full Registered Name

Date of Birth

Date

Country of Birth

Breeder Name

Sire

Dam

AKC CERTIFICATE - please upload a copy of the AKC registration Certificate*

B. HEALTH INFORMATION ABOUT THE DOG

Brand of Food

Supplements (if any)

Feeding Procedure

Amount, time(s), add water, etc

Chronic Illnesses, Injuries, or Issues

Arthritis, limping, broken bone, etc)

Medications

Medication Procedures

Microchip # (If applicable)

Allergies:(MEDICATIONS, ENVIRONMENTAL, ETC)

Date of Last Heartworm Test

Date

If the Dog is on regular heartworm preventative, state the brand name (for example, Heartgard or Interceptor)

and date of administration each month

Heartworm Preventative Brand

(Heartgard +, Trifexis, etc)

Day of administration each month

(Ex: 1st of month)

Vaccines

Rabies Certificate of Proof

Please upload proof of rabies

Practice Name/ Dr

Telephone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

C. BEHAVIOR INFORMATION ABOUT THE DOG

Unusual Habits (such as climbing, digging, anxiety, swallowing objects, eating too fast, etc.)

Describe Fully Previous Displays of Aggression of ANY TYPE (including food aggression, cage aggression, or aggression toward other animals or people, whether provoked or unprovoked) Add attachment if more space is needed.

D. OWNERSHIP INFORMATION ABOUT THE DOG

Name of Owner(s) of the Dog

Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code

Home Telephone

Work Telephone

Email Address

example@example.com

AUTHORIZATION. (Optional) Owner or Responsible Person authorizes and empowers Handlers to enter the Dog in dog shows. All entries will be charged directly to the Owner or Responsible Person's credit card.

The owner or responsible party agrees that cancellations must be made prior to NOON on the closing date of entries for particular show. After said deadline, if Owner or Responsible party decides to pull dog without handler's approval or have another handler exhibit dog, an invoice will be issued and owner will still be responsible for payment.

Who will be responsible for entering the dog at agreed upon shows?

Visa/MasterCard/Amex/ Discover #

Exp. Month

Exp. Year

Security Code

Handlers agree the dog will always be presented in a professional manner and that the handler and those under her supervision will conduct themselves proficiently and with good sportsmanship.
The handler agrees to abide by the rules of the AKC and local kennel club.
The dog will be fed a daily diet, watered regularly, exercised and properly housed in clean, safe quarters.
The dog will receive safe travel including proper airflow and temperature controls.
Professional photographs will be taken for the first win and all major wins thereafter, unless otherwise specified by owner. The owner or responsible party shall pay all costs of the photographs.
Handler agrees to make a good faith and a reasonable effort to handle the Dog personally at the shows for which entries have been made, and to exercise good faith in obtaining a substitute, if Handler cannot personally handle the Dog.
Owner or Responsible Person acknowledges:
- That Handler is responsible for showing dogs other than the Dog
- That conflicts in scheduling do arise because of the Local Kennel Club
- That on occasion Handler may not be able to personally handle the Dog, or may be unable to obtain a substitute handler for the Dog.
Owner or Responsible Person agrees that in the event of such a conflict, whom the Dog will be shown is in Handler's exclusive discretion. If for any reason the Handler feels the dog should be pulled Including but not limited to aggression, fear, or lameness; the Owner or Responsible Person will not be billed the handling fee for that day.
GROOMING: Owner acknowledges that when dog is in care of handler, the handler will make decisions on grooming, (ie: nails, trimming, etc to keep the dog in show condition.
ENTRIES: The owner acknowledges that they will pay for all entry fees and veterinarian fees.

FEES. If the dog will be staying for a period of time over seven (7) days, a deposit determined by Professional Canine, will be required at drop off. The Owner or Responsible Person agrees to pay Handlers fees for services performed as specified on rate sheet, unless otherwise agreed between both parties. Handlers agree to submit an itemized bill for all expenses and fees after each show. Owner or Responsible Person agrees to pay the bill and all outstanding balances upon pick up of dog. If the Handler's bill is not paid upon pick up of dog, a penalty fee of 10 % will be added to invoice per month. Should Handlers incur costs of collection, Owner or Responsible Person agrees to pay such costs, including a reasonable attorney's fee.

The Owner or Responsible party agrees that cancellations must be made prior to NOON on the closing date of entries for particular show. If owner decides to pull dog without handler's approval or have another handler exhibit dog, owner will still be billed an invoice and will pay.

INDEMNIFICATION AND HOLD HARMLESS. Owner or Responsible Person hereby agrees to indemnify and hold harmless Professional Canine Services, from any and all liability for, or which may result from execution of entry forms, transportation or housing of the Dog, any injuries inflicted by the Dog on other animals, on Handler, on Owner or Responsible Person, or on third parties, and any injuries which may be suffered by the Dog, including disability, disease, or death, from any cause, including but not limited to escape, running away, theft, fire, acts of God, natural causes, injury inflicted by third person or other unavoidable causes. In the event of illness or injury to the Dog, a qualified veterinarian will be summoned. The Owner or Responsible Person shall pay all costs required to care for the Dog and shall indemnify Professional Canine Services from any and all claims by any veterinarian summoned by Professional Canine Services. It is the express intention of the parties to this agreement that Professional Canine Services shall not be held liable to Owner or Responsible Person or to any third party or parties, for any acts of the Dog, no matter the circumstances, and Owner or Responsible Person personally agrees to be liable to Professional Canine Services for any such liability that may incur.

CONTRACT: Owner or Responsible Person and Handlers warrant that there are no other agreements with others in conflict with this Contract and no money is due to another party. This contract cannot be modified, except in writing and signed by both parties.

PRIZES: All trophies and ribbons will be handed to the Owner or Responsible Person upon pickup of said dog.

PHOTOS: Photos will be taken for the dog's first points and major wins, unless otherwise specified by Owner or Responsible party.

Photo Specifications

I have read the above, understand and agree to all terms and conditions. I have read, understand, and agree to the rates. I do not have any outstanding debt with another handler.

Print Name

Date

I, blanks as the owner of blank

give Jessica Herzon (Xclusive K9 Services) and/or Sandy Herzon and Johanna Herzon (Chambray Labradors & Professional Canine Services) and/or Ryan Herzon, permission to travel with said dog to shows in state or out of state as long as this agreement is in effect and to act as our representative while said dog is in their possession, as well as act as agents at all dog shows with said dog. Additionally, I hereby grant permission for Professional Canine Services and Xclusive K9 Services to treat or seek medical attention for said dog at their discretion, in case of illness and/or emergency, at my cost. Attached to this contract is an up to date copy of the dog's rabies, vaccines and medical information as well as their AKC certificate showing ownership.

Signature of Owner or responsible party

Date

Professional Canine Services

Veterinary Information

Duties of Handler

Travel Permission