Doggy Daycare Enrollment Form Step 1 of 4 25% A completed Enrollment Form and Pet Profile must be submitted for each pet before an evaluation can be scheduled for doggy day care. If you're registering more than one dog, you only need to select "New Client" for the first dog. You can then select "Existing Client" for each additional dog. Information and vaccination forms must be up-to-date while in daycare/overnight boarding. These can be faxed, mailed or dropped off.Thank you for your interest in our program.Are you a new or existing client?*New ClientExisting ClientHow did you hear about Karnik?*Check all that apply. Google Search Engine Google Ad Friend Family Karnik Team Member Facebook Pet InformationPlease fill out all required information.Dog's Name:*Breed:*Sex:*MaleFemaleWeight:*Age:*Minimum age for puppies is 12 weeks.Neutered or Spayed:*NeuteredSpayedNOT Neutered or SpayedDogs over age of 6 months MUST be spayed or neutered.How long have you had your dog?Color/Distinguishing Markings:Owner InformationAttention users with @aol.com or @umich.edu email addresses: AOL and U of M's spam filters are not allowing our emails to reach you. Please consider using a different email address when submitting your daycare enrollment. If you do use an email ending with either of these domains, we will still receive your request, but you may not receive a confirmation email. Thank you.Name:* First Last Address:*City:*State:*OhioMichiganAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip:*Email:* Enter Email Confirm Email Phone:*Alt Phone:Availability:*AnytimeMorningAfternoonEveningEmergency ContactName:* First Last Phone:*Alt Phone:Person(s) authorized to pick your dog up if you can't:Person 1:Person 2:Person 3:Veterinarian InformationYou must provide proof of current vaccinations before the evaluation day for our records. Please see "Health and Grooming" on the next page for requirements. You can have your vet fax them to Karnik On Black.Dr. Name:*Facility Name:*Phone:General InformationCollars Your dog is required to wear only a “Quick Release Collar” with a nametag containing at least your dog’s name, your last name and home telephone number. No choke collars or other types of collars are allowed on your dog during daycare. Evaluation Process 1. Upon completion of this form, someone will be in contact with you to schedule an evaluation session for your dog(s). 2. The evaluation of your dog takes place without the owner present. We do this to get a true evaluation of your dog's behavior. We will evaluate your dog's behavior in the presence of our staff and other dogs, both on leash and off leash to determine if your dog's temperament is appropriate for group day care. Health and GroomingYour dog(s) must be current on the following vaccinations: DHLPP (Distemper, Hepatitis, Leptospirosis, Parainfluenza, & Parvovirus), Bordetella and Rabies. Valid proof of vaccinations and fecal exam must be presented before pets can be evaluated for daycare. You also agree to keep your dog on heartworm preventative as well as preventative treatment for fleas and ticks. Pets arriving with fleas/ticks will be bathed at your expense at the minimum rate of $30.00.What flea/tick program is your dog on?*This is mandatory to attend.Does your dog have any allergies?*YesNoPlease list them:*Is your dog on any daily medications or have any medical issues?*i.e., hip dysplasia, limited vision, tender areas, etc.YesNoPlease explain:*BehaviorWhy do you want your dog to join our daycare?*ExerciseNot Home AloneSocializationDoes your dog have daycare experience?*YesNoHow much socialization has your dog done?*Extensive - Regular attendance at dog daycares. Lots of off leash time with other dogs.Moderate - Trips to dog parks, spent some time at daycare, going to dog related events, i.e., fundraisers, walks, etc.Minimal - Encounters on leash only, saying hello on walksNone - No socializationWhat type of player is your dog?*Frolic - Running/dancing with dogs, cat-like paw play, easy goingWrestler - Chase, vocal, cheek pullingRough - Non-stop player, constant engagementHow does you dog react to stress?*Does your dog have any resource aggression? (water, toys, balls, food, attention)*Does your dog like to or try to chase small animals?*YesNoHas your dog ever demonstrated aggressive behavior or bitten anyone or another animal?*YesNoWhat were the circumstances?*What level of obedience training do you do with your dog? Select all that apply.* Group Training Private Training Board and Train Home Schooling None Other Please explain:*How much do you use his/her training at home?*What is your dog's energy level?*High: Zoomer, chewer, very playful/eager to be active.Medium: Active dog that tires a bit easier.Low: Very relaxed most of the day with small play/exercise windows.How many daily walks do you take your dog on?*3+1 - 20 - 1Do you have multiple dogs? If so, how many?*Does your dog have any types of people or dogs that he/she tends to like/dislike? Describe briefly:*Does your dog know any specific commands other than the typical "Come", "Sit" or "Off"?*Are there things that scare/excite your dog? For example, doorbells, thunderstorms, meeting new people/seeing friends?*Please explain your dog’s behavior for each of the following areas:Digging:Jumping/Climbing (i.e. over fences? How high?)Other?I understand that I am responsible for informing Karnik® of any and all incidents of bites or aggression concerning my dog (dog to dog, dog to human etc.). Failure to do so may result in my daycare service agreement being terminated.* What you need to know about Group Doggy Day Care: This information is presented so that you, the Pet Owner, have an understanding of the benefits and risks that can occur in group doggy day care and agree to accept these risks. Please read the following: 1. Group doggy day care offers many positive experiences for your dog. The socialization with other dogs creates happier, healthier pets. It decreases boredom, which can lead to destructive behavior. It teaches your dog to be a dog and to have the proper “doggy” etiquette in dog-to-dog interaction. 2. While the positive experiences far out-weigh the negative, it is important for you to recognize there are risks with such activity. While Karnik’s staff watches the dogs carefully and DOES NOT admit known aggressive dogs, daycare can be hazardous due to multiple dogs playing together. Karnik® cannot be held responsible for injuries, illness, death and/or escape occurring while the dogs are playing, or any communicable disease or parasites while staying at Karnik®. 3. I understand and agree that my dog(s) will have access to a fenced outside area. I will not hold Karnik® liable if my dog(s) escapes (digging, jumping, or climbing). 4. Dogs not regularly exposed to the level of activity at Karnik’s doggy day care may feel the discomfort of sore muscles, sore joints and fatigue. From the outside play and playing on hard surfaces, they may also experience sore paws, blisters, bruise or abrasions on the feet (Raw Paw). 5. Dogs not regularly socialized may not know how to behave politely with other dogs. These dogs are at a higher risk of incidents including, but not limited to, bites, fear aggression, object guarding, behavior problems and/or acting out. 6. Dogs at play during the regular day do get dirty. Dogs with long hair can get matted from the level of activity at daycare. You can schedule baths and brush outs at an extra charge. 7. Please be sure that your dog(s) do not have excessively long toenails, as these may cause injury to your dog. 8. While Karnik’s daycare areas are continuously supervised, this does not mean Karnik’s staff can prohibit or control all “incidents” that may occur. 9. Water is available at all times; however, your dog may still be thirsty when it gets home from daycare. We recommend limiting water intake when they get home, as excessive amounts may cause an upset stomach or other problems. Also, I understand that my dog(s) will be sharing water bowls in a community setting. 10. There are limitations on group doggy day care. If your dog displays aggressive behavior, for the safety and health of your dog and others, your dog will be confined to one of our boarding suites for the remainder of that visit with no offset or reduction in price. Any controversy or claim arising out of or relating to this Agreement, or the breach there of, 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. By checking the box below, I state that my dog(s) is/are in good health and have not been ill with any communicable condition in the last 30 days and that my dog(s) have never harmed or shown aggressive or threatening behavior towards any person or any other dog. I also understand that I am solely responsible for any harm caused to my dog(s) while my dog(s) is/are attending Karnik® and release Karnik® of any liability arising from my dog’s attendance and participation at the daycare. Because of this, I agree that Karnik On Black must keep a valid credit card number on file. The Pet Owner agrees that Karnik’s liability shall in no event exceed the lesser of the current tangible value of a pet of the same breed or the sum of Five hundred ($500.00) dollars per animal as outlined in our Healthy Pet Program. This agreement is intended to be as broad and inclusive as permitted by the laws of the State of Ohio and Michigan, and that if any portion thereof is held invalid, it is agreed that the balance shall continue in full legal force and effect. It is also understood that should a court determine that any provision waiving liability is deemed unenforceable, Karnik’s liability shall be limited to the funds paid to Karnik® by the pet owner for taking care of my/our pet(s). I acknowledge and accept that all the above policies refer to daycare, as well as boarding stays, and this agreement serves as accepting these conditions for both services.* Authorization for Emergency Medical Treatment I, the dog owner, do hereby authorize and consent to such medical services or care which are necessary or appropriate for my dog, including the selection of veterinary personnel and facilities and transportation or transfer of my dog to such facilities and in connection with such treatment, services and/or care, to authorize and consent in my name and on my behalf to such emergency or necessary surgery, diagnostic or corrective, as they may determine to be necessary for the life, health or well being of my dog, after reasonable consultation with duly licensed veterinarians. It is understood that reasonable effort shall be made to contact me prior to rendering treatment to my dog, but that any of the above treatment will not be withheld if I cannot be reached. It is understood that I will be financially responsible for any expenses above and beyond the amount specified as follows: Authorized Medical Amount:*$100.00$300.00$500.00$1,000.00$2,000.00No LimitMy initials below acknowledge that I agree to the above terms and also authorize the use of my credit card for said purpose. This authorization shall remain in effect for all visits unless a new one is signed.*NameThis field is for validation purposes and should be left unchanged.