MIK9 Waiver

Client*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact*

First Name (Please put down someone other than yourself)Last Name

Emergency Contact *

Please enter a valid phone number.

Where did you hear about MIK9?

Please provide more information about how you found us! We'd love to thank whoever sent you our way!

Please List Your Dog's Current Animal Hospital: *

Please notify the MIK9 Team if this changes so that we can keep our records updated in case of any emergencies.

Dog's Name:*

Dog's Age:*

Please List Any Known Allergies to Food/Medications:*

Please Write N/A If None

Please List Any Major Medical Concerns/History:*

Please Write N/A If None

Do you have another dog that attends our services?*

YesNo

Dog's Name:*

Dog's Age:*

Please List Any Known Allergies to Food/Medications:*

Please Write N/A If None

Please List Any Major Medical Concerns/History:*

Please Write N/A If None

Do you have another dog that attends our services?*

YesNo

Dog's Name:*

Dog's Age:*

Please List Any Known Allergies to Food/Medications:*

Please Write N/A If None

Please List Any Major Medical Concerns/History:*

Please Write N/A If None

Do you have another dog that attends our services?*

YesNo

Dog's Name:*

Dog's Age:*

Please List Any Known Allergies to Food/Medications:*

Please Write N/A if None

Please List Any Major Medical Concerns/History:*

Please Write N/A If None

Do you have another dog that attends our services?*

YesNo

Dog's Name:*

Dog's Age:*

Please List Any Known Allergies to Food/Medications:*

Please Write N/A If None

Please List Any Major Medical Concerns/History:*

Please Write N/A If None

Do you have another dog that attends our services?*

YesNo

Dog's Name:*

Dog's Age:*

Please List Any Known Allergies to Food/Medications:*

Please Write N/A If None

Please List Any Major Medical Concerns/History:*

Please Write N/A If None

Do you have another dog that attends our services?*

YesNo

Dog's Name:*

Dog's Age:*

Please List Any known Known Allergies to Food/Medication:*

Please Write N/A If None

Please List Any Major Medical Concerns/History:*

Please Write N/A If None

Do you have another dog that attends our services?*

YesNo

Dog's Name:*

Dog's Age:*

Please List Any Known Allergies to Food/Medications:*

Please Write N/A If None

Please List Any Major Medical Concerns/History:*

Please Write N/A If None

Do you have another dog that attends our services?*

YesNo

Dog's Name:*

Dog's Age:*

Please List Any Known Allergies to Food/Medications:*

Please Write N/A If None

Please List Any Major Medical Concerns/History:*

Please Write N/A If None

Do you have another dog that attends our services?*

YesNo

Dog's Name:*

Dog's Age:*

Please List Any Known Allergies to Food/Medications:*

Please Write N/A If None

Please List Any Major Medical Concerns/History:*

Please Write N/A If None

Do you utilize our virtual training services?*

Yes, I participate in virtual training sessions with a team member.No, I only utilize in person services.

Do you give us permission to record and use your training sessions/group classes/training content for any of our social media platforms, membership page, and podcast?*

Yes, you can record our sessions/training content and use it for social media/broadcasting purposes.No, I do not wish to be recorded and used for social media/broadcasting purposes.

Do you give us permission to record and use your virtual consultation for any of our social media platforms, membership page, and podcast?*

Yes, you can record our sessions and use for social media/broadcasting purposes.No, I do not wish to be recorded and used for social media/broadcasting purposes.

As a virtual client, do you ever plan to utilize our in person services?*

Yes! Look forward to meeting you guys some day!No, virtual only.

MIK9's focus for all dogs is to teach boundaries, healthy coping mechanisms, and neutrality in order to introduce play and excitement in a safe and healthy way. During our socialization services, this will be our main focus over "free for all" play time.*

I understand that the main goal for every dog is to have their physical and mental needs fulfilled and that my dog will spend the day learning how to socialize in the healthiest way possible for them. I agree to notify the MIK9 team if I have questions or concerns about my dog's progression with any of the MIK9 services.

Behavioral changes noticed at home are important for the MIK9 team to be aware of in order to offer the best support to your dog and maintain a safe environment for all.*

I agree to notify the MIK9 team of any behavioral changes I notice at home and understand that this will allow MIK9 to better understand my dog to give the support they may need.

Life events, such as a move or family emergencies, can play a large role in a dog's behavior. In order to best support your dog and maintain a safe environment, it's important for the MIK9 team to be made aware of big changes so we can support them through it or prevent issues from arising.*

I agree to notify the MIK9 team of changes in the home so that they are best able to support my dog during the changes. I understand that this allows the team to also watch for behavior changes.

If your dog is feeling unwell, please keep your dog at home and notify the MIK9 team immediately. Additionally, if your dog seems to be unwell while attending any of our services, we may ask that the dog(s) is/are removed from that service until feeling better or cleared by a veterinarian.*

I agree to keep my dog home if they are unwell. I understand that MIK9's goal is to keep the pack as healthy as possible.

In case of your pet needing medical attention while in our care, you allow the MIK9 team to transport your dog to a local veterinarian and authorize our team members to act if an emergency situation arises.*

I understand and agree that the MIK9 team will transport and authorize services that are deemed necessary by the veterinarian in an emergency situation. I understand that I am responsible for any financial invoices for the services that are performed. I understand that the MIK9 team will keep me updated and included in the situation if it was to arise.

I understand that my dog may be used for social media or membership purposes. I agree that Mirror Image K9 can use video and photographs of my dog on all platforms of social media and membership pages.*

Mirror Image K9 can use my dog's name in social media posts/membership page.Mirror Image K9 cannot use my dog's name in social media posts/membership page.

I, the client, have read and understand the statements above. I understand that I must uphold my portion of this agreement in order to allow my dog to be properly cared for by the MIK9 team. I understand that there may be changes or updates to the agreement and I will notify MIK9 of any changes. I understand MIK9 will notify me with any changes or updates to this agreement.*

I, the client, agree to all of the statements above. I understand the requirements of me and I will uphold my portion of these agreements.

Waiver, Medical Power of Attorney, Authorization and Acknowledgements:

I, (Client) the undersigned owner of (Dog) do hereby release, indemnify and forever hold harmless Mirror Image K9 LLC., a Georgia LLC., its employees, officers, investors, agents, subcontractors, customers, visitors and guests (collectively, Mirror Image K9) from any and all liabilities (including attorney’s fees) arising out of or connected with injuries, illness, loss, death, damage or other harm to myself, my dog, my property, and my guests and invitees which arise in any way out of services and/or products provided by or as a consequence of my association with Mirror Image K9. This Agreement is binding upon Client, spouse of Client, and children of Client. This Agreement supersedes all prior discussions, representations, warranties, and agreements of the parties, and expresses the entire agreement between Client and Mirror Image K9 regarding the matters described above.

The parties confirm that, except for that which is specifically written in this Agreement, no promises, representations or oral understandings have been made. Without limiting the generality of the foregoing, the Client acknowledges that Mirror Image K9 has not represented, promised, guaranteed or warranted that Dog will never bite, that Dog will not be dangerous or vicious in the future, that Dog will not exhibit other behavioral problems, or that the results of the training will last for any particular amount of time. This Agreement may be amended by a written instrument signed by both Client and Trainer.

The client further acknowledges, agrees and understands that they must practice with their dog in- between sessions/classes what they learned during each lesson and that follow-up and scheduling of future training sessions is their sole responsibility. If my dog(s) causes property damage, or bites or injures any dog, animal or person (including but not limited to Mirror Image K9 and those affiliated with Mirror Image K9) during or after the term of this Agreement, I agree to pay all resulting losses and damages suffered or incurred, and to defend and indemnify Mirror Image K9 and those affiliated with Mirror Image K9 from any resulting claims, demands, lawsuits, losses, costs, or expenses, including attorney fees. If my dog(s) is injured in a fight or in any other manner during or after the term of the Agreement, I assume the risk and agree that Mirror Image K9 should not be held responsible for any resulting injuries, losses, damages, costs or expenses.

Mirror Image K9’s services will terminate if (a) in Mirror Image K9’s sole judgement the dog(s) is dangerous or vicious to Mirror Image K9 or any other personal or animal, or interferes with the training of other dogs, or (b) the Client breaches any term or condition of this Agreement. Upon termination in accordance with the foregoing, Mirror Image K9’s duties shall terminate but all other provisions of this Agreement shall continue in full force and effect. I am fully aware that Mirror Image K9 encourages proper off leash and on leash socialization and interaction of dogs in its custody and care and accordingly I assume any and all risks related to Mirror Image K9 's performance of its services, including but not limited to bites, bodily injury, illness and disease, theft, falls, collisions with vehicles, natural disasters and death. I also agree to assume all liabilities, costs, damages, claims and expenses that may occur as a result of my pet’s actions.I understand and approve the use of any training tools that the Mirror Image K9 deem necessary and in the best interest of the animal. These include but are not limited to basket muzzles, electronic training collars, treadmills, transitional leads, and slip leads.

The client agrees, understands and acknowledges that the elimination or modification of behaviors is not guaranteed. The client acknowledges that dog training will not provide exact results and that failure to follow the professional advice given to them by Mirror Image K9 may result in an escalation of behavior and training issues. The client further agrees to accept responsibility for any damages the client’s dog may cause through malicious, aggressive or improper behavior that may occur before, during or after all services provided by Mirror Image K9 . Furthermore, the client understands and agrees that if their dog is injured in a dog fight or an accident, gets fleas, ticks or worms, contracts any illness or disease, is lost or stolen, becomes pregnant, or engages in any dangerous, vicious or unwanted behavior, during or after all services provided by Mirror Image K9 , on or off Mirror Image K9 premises, the client’s home or business or any other location, that the client accepts the risk and indemnifies Mirror Image K9 against it and any other resulting injuries, losses, deaths, damages, costs or expenses.

This Agreement supersedes all prior discussions, representations, warranties and agreements of the parties, and expresses the entire agreement between Client and Mirror Image K9 regarding the matters as described previously in this Agreement. The parties confirm that, except for that which is specifically written in this Agreement, no promises, representations or oral understandings have been made with regard to the Dog or anything else.

If, in my absence, my dog should be injured, become ill or suffer an ailment or is otherwise deemed by Mirror Image K9 to require immediate medical attention, Mirror Image K9 , in its sole discretion, is authorized to make all health care decisions on my behalf, and may utilize the services of a licensed veterinarian of Mirror Image K9’s choosing to administer medicine or give other requisite attention to the pet at my sole expense. I am responsible for any and all charges made on my behalf by Mirror Image K9 for such services, and I authorize Mirror Image K9 to pay on my behalf and bill me for such services. I agree to reimburse Mirror Image K9 in full for any veterinary services deemed necessary.*

I hereby indemnify Mirror Image K9 from any action, claim, demand or lawsuit (including attorney’s fees) arising out of or connected with the charges made by any veterinarian caring for my dog. In the highly unlikely event that my dog’s end of life decisions need to be made in my absence, I authorize Mirror Image K9 to make such decisions on my behalf at my sole expense.*

I hereby certify and represent that my dog is in good health and has not been ill with any communicable condition in the last 30 days. I also represent that my pet is current on its vaccinations for Rabies, Bordetella, and DHPP and has had a negative intestinal parasite screening within the last year. I further certify that my dog has not harmed or shown aggressive or threatening behavior towards any person or any other dog or animal. I understand that Mirror Image K9 reserves the right to refuse use of Mirror Image K9 facilities and services or to rescind attendance rights for dogs who, in Mirror Image K9's sole determination, act aggressively, are undisciplined, evidence inappropriate behavior or who might otherwise be a danger to themselves, other animals or people. I certify and represent that all of the information provided to Mirror Image K9 in writing or otherwise relating to myself and my dog is true and correct.*

I agree that my dog may appear on Mirror Image K9's website, social media, in advertising, printed materials, promotional videotapes, news programs and/or other press, including magazines, radio, television and/or internet coverage if released in earlier statements.*

I specifically represent that I am the sole owner or agent of the owner of the above listed pet(s), and that I am authorized to enroll and place this pet in the services provided by Mirror Image K9 and sign this contract. I will immediately notify Mirror Image K9 of any changes to what I have represented above.*

Cancellation Policy:
I agree to pay a nonrefundable fee per session to be paid at the time of session. I agree if I fail to give at least 72 hours cancellation notice to pay a cancellation fee in the amount of 25% of the reserved services. I agree if I am not present at the time of scheduled appointment, full session fees are still due. I understand that rescheduling a session may mean a wait of one to two months. In the event of a true, unavoidable emergency, your cancellation fee may be waived.*

Although we carefully screen all applicants, occasionally we discover that this is not an appropriate service for every dog. Mirror Image K9 LLC reserves the right to permanently remove a dog from our services at any time.

By signing below, I acknowledge that I have read, understand and accept the terms outlined above and I accept exclusive and sole responsibility for these and all other risks and release Mirror Image K9 of all liability, no matter the cause. I also acknowledge that I am financially responsible for all charges made, and that all services, rates, policies and procedures are subject to change without notice. I certify that I have read and understand the rules and regulations set forth herein and that I have read and understand this agreement. I agree to abide by the rules and regulations and accept all the terms, conditions, and statements of this agreement and confirm the truthfulness of the contents of the Application form completed by me.

Please sign below, noting that all of the information is correct and up to date and that you have read/understand the terms and agreements.

Signature*

MIK9 Waiver

Dog's Information

Owner's Commitments

MIK9 Service Waiver and Agreements