Client & Dog Information

Your Name

Referred by

Home Phone

Work Phone [text*WorkPhone]

Cell Phone [text*CellPhone]

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

Medical History Notes:

May We Share Your Training and Behavior Report with your Veterinarian?

 yes no

Home Information

Other Professionals, Service Providers, or Visitors Expected During Training Hours

Others Who Hold Keys to the Home

Days Okay for Training Visits

 M T W Th F Sat Sun

Times Okay for Training Visits (Please specify am or pm): Between

and

Description of Services

Description of Services:

Rate

Total Due

Liability Waiver and Policies

1. (Purely Positive Dog Training LLC) will endeavor to create as safe an environment as possible for the training and of my dog and will offer only sound, safe, and responsible training, and post-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 and I hereby agree to indemnify and hold harmless (Purely Positive Dog Training LLC) of any and all claims of injury, expense, costs, or damages caused by the actions of my dog while under (Purely Positive Dog Training LLC) care and under my own care as a result of following training instructions. I have been told by (Purely Positive Dog Training LLC) and understand the inherent risks in owning a dog, including but not limited to the risk of dog bites to myself or others.

2. I authorize (Purely Positive Dog Training LLC) to enter my home during agreed upon days and hours for the purpose of training my dog.

3. I authorize (Purely Positive Dog Training LLC) to take my dog off my property during the agreed upon days and hours for the purpose of training my dog.

4. I authorize emergency medical care to be provided for my dog(s) by the above-named veterinarian, or an appropriate alternate to be determined by (Purely Positive Dog Training LLC) in the event that my regular veterinarian is not available or that closer care is required. I will reimburse (Purely Positive Dog Training LLC) for any charges related to emergency care, including office visits, procedures, medications, surgeries, etc.

 YES I authorize (Purely Positive Dog Training LLC) to administer or seek 1st aid and rescusitive care for my dog(s) as determined appropriate by (Purely Positive Dog Training LLC) and I agree to indemnify and hold harmless (Purely Positive Dog Training LLC) for all and any results thereof.

 NO I DO NOT authorize (Purely Positive Dog Training LLC) to administer or seek 1st aid and rescusitive care for my dog(s) as determined appropriate by (Purely Positive Dog Training LLC) and I agree to indemnify and hold harmless (Purely Positive Dog Training LLC) for all and any results thereof.

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

Electronic Signature:

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