Pool Registration Form - American K9 country

Pool Release Form

Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone/Mobile

Dog's Name

Dog's Breed

Dog's Age

Proof of Vaccines

I understand that I must provide current, up-to-date vaccination information at drop off for Rabies, Distemper/Parvo & Kennel Cough for Dogs & Rabies and Feline Distemper for Cats. This information must be on Veterinary Letterhead. Rescue Organizations are NOT adequate proof of vaccines.

Initial Below

Date of Initials

Has your dog swam before?

Yes

Has your dog used an Underwater Treadmill before?

Yes

Reason for visit

Just FUN

Fitness/ Exercise

Does your dog have a preexisting injury we should know about?

Release and agreement to hold harmless and indemnify, and assumption of risk.

By Checking Each Box you are agreeing to Assumption of Risk.

Assumption of Risk Agreement

I understand that PETS SWIM AT YOUR OWN RISK!

I understand that Humans are NOT allowed in the Pool or Treadmill at ANY TIME!

I understand that NO ONE under the age of 16 years of age is allowed in the pool or fitness rooms.

I understand that NO MORE than 4 dogs may be in the pool room at a time.

I agree to pay a $200 cleaning fee if my dog defecates in the Pool or Under Water Treadmill

I agree to allow Ak9C to charge my credit card on file for any damages that result either directly or indirectly from myself, my guests &/or my dog’s pool &/or treadmill session.

Pool & Fitness Room Release: I fully realize and acknowledge the hazardous nature and danger of swimming and utilizing an underwater treadmill. I further understand that American K9 Country Inc. and the foregoing released parties assume no responsibility for having a lifeguard on duty and that all dogs using said facility are in a “swim at your own risk” facility and that I fully assume the risk of my dog’s injury, sickness, damage, loss or death associated with such participation in the swimming/fitness events which may transpire while we are using the pool &/or fitness facilities including but not limited to the Indoor pool & Underwater Treadmill. I agree that there are inherent risks to me associated with the use of American K9 Country’s facilities arising out of or associated with use and conditions such as wet floors, exercise mats, therapy equipment, equipment failures and other animals. In consideration for American K9 Country granting me permission to use their facilities, I agree to release American K9 Country from liability arising out of or associated with such use, and hereafter waive any and all claims which may arise out of or be associated with such permissive use of the facilities.

I hereby release American K9 Country, its employees, officers, instructors, members and agents from any and all liability of any nature, for injury or damages which I or my dog or my guests may suffer, arising from the action of this organization, its employees, officers, members, and agents or any cause whatsoever including specially, but without limitation, any injury while attending any pool, treadmill &/or fitness session, or any other function of this organization, or while on the facility’s grounds or the surrounding area thereto.

I hereby agree to indemnify and hold harmless this organization, its employees, officers, members, and agents from any and all claims, or claims by any member of any family or any other person accompanying me to any pool &/or treadmill session or function to the organization, or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own, or any action by employees, officers, members or agents of the organization including any action by the instructors, or by employees, officers, members, and agents from the organization.

Note: All signatories must be 18 years of age or have parent or legal guardian signature.

Signature

Sign Here

Date of Signature

Pool Contract Form

Release and agreement to hold harmless and indemnify, and assumption of risk.