ULTIMUTT University Training Application

Name*

First NameLast Name

Phone Number*

Email*

example@example.com

Dog's Name*

Dog's Date of Birth*

Date. If unsure, please guess approximate Date.

Approximate Weight*

In Lbs.

Breed and Color*

Upload a current photo of your dog here

Is your dog:

SpayedNeuteredIntact

Are there other pets in your household? If so, list name, type and age.*

Medical History and Information

VACCINATIONS

We require proof of the following:

• *Bordetella (the intranasal 6 month that includes Adenovirus, Parainfluenza, and Bordetella is highly recommended)

• *Canine Influenza (H3N2 or H3N2/H3N8.The combination vaccine is highly recommended. Both the first shot and booster required before attending.)

• Rabies 1 year or 3 year (once old enough for puppies)

• DHLPP annual or equivalent (or puppy series)

*The first two are not part of the regular vaccines routinely given and have to be asked for. Your dog must have the second Flu Shot before attending daycare.

Does your dog have any food allergies? If yes, please list here.*

If Not, type None

Past Experiences and Training Questions

Which best describes your dogs energy level?*

LowMediumHIgh

Are there any types of PEOPLE that your dog dislikes? Please explain.*

If Not, type None

What do you hope to get out of the training with your dog? Your goals:*

Has your dog had any prior training, at home or professionally? If so, please list here.*

If Not, type None

Which obedience commands does your dog respond to consistently?*

Are you interested in additional training after completing Beginner Obedience? :*

YesNo

Is your dog crate trained?*

YesNo

Does your dog have any problems in the following areas:*

Has your dog ever bitten anyone?*

NoYesIf yes, please explain

If Yes is marked above, please explain:

Please provide other comments or information about your dog that you feel might be helpful:

How did you hear about us?*

If referred by a friend, please tell us who so we can thank them:

Image Release*

I grant permission to post pictures of my dog(s) with their name on Ultimutt Knoxville website, on social media (Facebook, Instagram, etc.) and/or in other print and video/TV media related to Ultimutt Knoxville.I grant permission to post pictures of my dog(s) without their name on Ultimutt Knoxville website, on our public social media pages (Facebook, Instagram, etc.) and/or in other print and video/TV media related to Ultimutt Knoxville.

I understand that I am solely responsible for any harm caused by my dog while my dog is attending Ultimutt Knoxville. I further certify that my dog has not harmed or shown aggressive or threatening behavior towards any person or any other dog.
I hereby certify that my dog(s) are/is in good health and has not been ill with any communicable condition in the last 30 days.
I understand I must provide proof of the Center’s vaccination requirements for my dog(s) prior to their first visit, and annually thereafter.
My dog has not been exposed to rabies, distemper, bordetella, canine influenza, lepto, or any other contagious or communicable disease within a thirty-day period prior to being left for daycare, training, fitness center, or other add-on services. I agree to notify the Center of any exposure to any virus, infection or other transferable illness and will not bring my dog to the Center until he/she is symptom free for a reasonable period to be determined by my dog’s veterinarian, or until written approval is obtained from a veterinarian.
I further agree not to bring my dog to the Center if he/she is exhibiting signs of illness that may be harmful to other dogs in attendance, such as: vomiting, diarrhea, extreme lethargy, etc. without first obtaining approval from the Center.
I further understand and agree that dogs can sometimes receive minor cuts and scratches during training, and any problems that develop with my dog will be treated as deemed best by staff and volunteers of Ultimutt Knoxville, at their sole discretion, and that I assume full financial responsibility for any and all expenses involved.
I further understand while my dog is in the care and custody of Ultimutt Knoxville, if I am unreachable in the event of an emergency, I hereby authorize Ultimutt Knoxville, its agents, and/or representatives to seek immediate veterinary care for my dog. I understand that all costs in connection with veterinary, medical, or other treatment shall be my responsibility.
I further understand that if on the Application Form(s) I selected that Ultimutt Knoxville has permission to use photos of my dog(s), the Center may post or reproduce any and all photographs taken on or in, without limitation, the Ultimutt Knoxville website, promotional materials and merchandise, without becoming liable to the Owner (or the Owner’s pet) or any royalty payment of any kind.
I further understand that by listing emergency contacts and/or authorized caretakers on my Application Form(s), the Center has permission to contact list listed.
I further acknowledge that I am the sole owner of the pet (which Owner is delivering to Ultimutt Knoxville pursuant to this Contract), free and clear of all liens and encumbrances.
I hereby release and agree to save and hold harmless Ultimutt Knoxville, its directors, officers, shareholders, employees, assistants, members, and agents from any and all liability, claims, suits, actions, loss, injury, or damage of any nature or kind, or for any liability claims, suits, actions, loss, injury or damage which I or my dog may sustain or which may be caused in any way by my dog. I specifically, without limitation, agree to fully indemnify Ultimutt Knoxville for any and all such liability, claims, suits, actions, losses, injury, or damage.

Owner hereby certifies that Owner has read and understands this Waiver and Release of Liability and the regulations set forth above. By signing this agreement, Owner agrees to be bound by its terms and conditions.

By e-signing this form, I accept the risks in the statements in the waiver above and I certify that the information provided in this form is accurate and true to the best of my knowledge. *

Ultimutt University Training Application

Final Details