Form

OBEDIENCE PRIVATE TRAININGS

Preferred Start Date of PrivateTraining*

Month/Day/Year

Preferred Start time of Training

Location:*

Number of Dogs*

First name*

Last name*

Email*

Main Phone*

Street address*

City*

State/Region*

zip code*

Dog's Name*

Is your dog:

Male

Female

Dog's Breed

Dog's DOB

Has this dog been neutered/spayed?

Did you notice any differences after neutering/spaying? If yes, please describe:

Has this dog bitten another person or animal? If yes please explain:*

What would you like to focus on in training?

What other trainings have you done with your dog?

Where/with whom have you trained and what type of training was it (i.e.postive reinforcement, dominance, etc)

What is your dog's favorite reward?

Does your dog like to play and if so what is your dogs favorite ways to play?

Do you or your dog have any allergies or physical limitations that would affect training? If so what are they?

How did you hear about Patience Inspired Dog Training?

Please attach proof of vaccinations for rabies, parvo, distemper and kennel cough (photo or scan of last vet bill will work)

What is the Name of your Veterinarian and did they refer you?*

and the Veterinary Hospital/Practice they work at?*

Is there any other information you feel would be important for us to know about your dog that wasn't covered?

Waiver, Assumption of Risk and Hold Harmless Agreement: I understand that attendance at a dog training class of any kind is not without risk to myself, members of my family or guests who may attend, or my dog, because some of the dogs to which I (we) may be exposed may be difficult to control and may be the cause of injury or illness even when handled with the greatest of care. I agree that I will abide by all safety rules and requests provided by Patience Inspired Dog Training employees and representatives. I hereby waive all claims for damage and release and forever discharge Patience Inspired Dog Training employees, instructors, assistants, volunteers, and representatives from any and all claims, damages, losses, or liabilities of any nature, for injury or damage which I,my dog, or my guests may suffer in connection with my attendance or participation in training sessions,including specifically, but not without limitation, any injury or damage resulting from the action of any dog. I expressly assume the risk of such damage or injury when attending any training sessions or other function, or while on the training grounds or the surrounding area thereto.I hereby agree to indemnify, defend and hold harmless Patience Inspired Dog Training and any other location,their employees, instructors, assistants, volunteers, and representatives from any and all claims,damages, losses or liabilities, whatsoever arising out of or resulting from (1) my presence at or participation in any training session or other function while at Patience Inspired Dog Training or any other location or the surrounding areas thereto, (2) the presence at or participation by any member of my family or any other person accompanying me to any training session or other function while on the grounds or the surrounding area thereto and (3) any action by any dog, including my own.I understand that the handler of this dog is responsible for controlling the dog at all times during the training session or class, both during the training sessions and on the grounds where the training sessions are held. A dog and handler may be removed from class at the instructor’s discretion should the handler be unable to control the dog.I understand that if I wish to cancel, I must give notice to Patience Inspired Dog Training at least 24 hours prior to the first class or training session meeting in order to receive a full refund. There are no refunds or credits of fees after the class sessions have started.

I have read the Waiver, Assumption of Risk and Hold Harmless Agreement carefully and fully understand and agree to it's terms.*

Upload a picture of your dog (optional)

Photo/Video Release*

Patience Inspired Dog Training requests your permission for the display, distribution, publication, transmission or otherwise use of photographs, images and/or videos taken for use in materials that include, but may not be limited to, printed materials such as Brochures, Newsletters, Videos and digital images used on Patience Inspired Dog Training’s Website and Social Media Pages, such as Facebook.