Form

Start date*

First Name*

Last Name*

Email*

Street address*

City*

State/Region*

zip code*

Phone Number*

Dog Name*

Dog's Breed*

Dog's DOB*

Number of Dogs*

Has this dog been neutered/spayed?*

What is your dog's favorite reward?*

How many times a day do you feed your dog?*

Has your dog bitten a person/dog? If so, please explain.*

Has your dog been banned from any daycare or play group in the past?*

Describe your dogs energy level. " low, medium, high"*

Does your dog have any allergies or medical conditions that would effect him/her running,playing etc? If so, what are they?*

Is your dog on any medications, including herbal/over the counter? If so please list:*

Describe your dog's reaction to being left alone at home:*

Does your dog bark or react to other people/dogs while on leash ?*

Does your dog have a low prey drive? " Sees a squirrel, rabbit, etc but shows little to no interest in it"*

Does your dog have a preferred area in your yard to eliminate, and if so where?*

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

Does your dog live with other pets, in if so how do they get along?*

Does your dog suffer from separation distress?*

Yes

Do you use a crate, and if so how long on average is your dog in it on a normal day?*

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

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

What is the Name of your Veterinarian?*

and the Veterinary Hospital/Practice they work at?*

Please attach proof of vaccinations (photo or scan of last vet bill will work)

Upload a picture of your dog (optional)

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.*

Photo/Video Release*