Client & Dog Information

Your Name

Referred by

Home Phone

Work Phone

Cell Phone

Street Address

City Zip

Email

Dog 1 Name/ID

Dog 1 Breed/Age/Sex

Dog 2 Name/ID

Dog 2 Breed/Age/Sex

Emergency & Health Information

Emergency Contact

Phone

Vet Office/Vet Name

Veterinarian's Phone

Current Medications

Reason(s) for Meds

Dog's Recent Vaccination History:

Dog's Food, Treats, Dietary Restrictions, etc.:

Description of Services

Name of Class:

Date/Time

Class Fee

Liability Waiver and Policies

1. Purely Positive Dog Training LLC will endeavor to create as safe an environment as possible for the training of my dog and will endeavor to offer only sound, safe, and responsible training and training instructions. However, I recognize that Purely Positive Dog Training LLC is not responsible for any unintentional errors, omissions, or incorrect assertions. I understand that the recommendation of any other product or service is not a guarantee of my satisfaction with that product or service. Further, I am and will remain responsible for the actions of my dog at all times. I hereby agree to abide by the rules and policies of Purely Positive Dog Training LLC training classes as set forth in this contract. I understand that attendance of dog training classes is not without risk to myself, members of my family, guests who may attend, or to my dog. In consideration of, and as inducement to the acceptance of my application for training membership in this training class, I hereby agree to indemnify and hold harmless Purely Positive Dog Training LLC , its officers, directors, instructors, agents, employees and/or representatives of any and all claims, or claims by any member of my family, or accompanying guests of mine of injury, expense, costs or damages to myself, my dog or any handler sponsored by me both in class and out of class. In addition, I agree that I will defend and indemnify Purely Positive Dog Training LLC for any injury, expense, costs or damages to any dog handlers or dogs, whether sponsored by me or not, or to third parties arising out of my own actions or the actions of my dog. I have read the above-stated provisions, and agree to accept those responsibilities.

This contract is validated by the electronic signatures below in total and as approval for future services without additional written authorization.

Electronic Signature:

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