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Getting to know you
Please fill out the form to the right so we can get to know a bit about you and your dog’s needs.
1
Client and Dog Information
2
Risk Waiver
Your information
Your Name
*
First
Last
Email
*
Phone
*
How did you hear about us?
Yahoo
Google
Friend
Other...
Please specify how you heard about us
*
Your dog's information
Dog's Name
*
Dog's Breed
*
Dog's Age
*
Weeks/Months/Years
*
Weeks
Months
Years
Dog's Gender
*
Male
Female
Spayed/Neutered?
*
Yes
No
Emergency and Health information
Veterinarian/Vet Office
*
Vet's Phone
*
May we share your training and behavior report with your vet?
*
Yes
No
Is your dog currently on any medications?
*
No
Yes
Please list and explain the type and reason(s) for each medication your dog is currently taking.
*
Does your dog have any medical conditions?
*
No
Yes
Please explain
*
What behavioral condition, if any, has brought you to Canine Phd?
Does your dog have any dietary restrictions?
*
No
Yes
Please explain
*
What food are you feeding your dog?
Behavior Information
Why did you get a dog?
*
Why did you choose this specific breed?
*
Please tell us all behavior problems and obedience training you would like to address during your lesson.
*
Has your dog ever shown aggression towards other dogs?
*
Aggression includes growling, showing teeth, snapping and biting.
No
Yes
If "Yes", please explain below.
*
Has your dog ever shown aggression towards people?
*
Aggression includes growling, showing teeth, snapping and biting.
No
Yes
If "Yes", please explain below.
*
Has your dog ever bitten a person?
*
No
Yes
If "Yes", please describe the incident below.
*
Has your dog ever bitten another dog?
*
No
Yes
If "Yes", please describe the incident below.
*
ASSUMPTION OF RISK
The undersigned is aware of the inherent risks of injury, death, and property damage to the undersigned or his or her dog that are involved in the activity of training, including without limitation risks due to dog bite or infectious disease. The undersigned is aware of the risks of injury, death and property damage that may result from, among other causes, the active or passive negligence of CANINE Ph. D. Inc, its owners, officers, directors, employees, or agents (hereafter referred to as THE RELEASED PARTIES), including without limitation the risk of negligent instruction or supervision. The undersigned is voluntarily engaged in training as an activity with knowledge of the risks of injury, death, property damage, and other risks and assumes any and all known and unknown risks injury, death, and property damage that may result from participation in training.
RELEASE OF LIABILITY
The undersigned releases THE RELEASED PARTIES from all liability to the undersigned and the undersigned's representatives, guardians, successors, assigns, heirs, children, and next of kin for all liability, claims, damage, or demands for personal injury, death or property damage to the undersigned or to the undersigned's dog or dogs, arising from or related to this agreement or to participation in training, whether the injury, death or property damage occurs on or off the PREMISES.
This release includes, without limitation, any personal injury, death, or property damage caused by the active or passive negligence of any of THE RELEASED PARTIES. The undersigned acknowledges that he or she has carefully read this agreement, understands its contents and understands that this agreement includes an assumption of the risk of THE RELEASED PARTIES' negligence and a release of their liability. The undersigned acknowledges that THE RELEASED PARTIES are materially relying on this waiver in allowing the undersigned to use the PREMISES to engage in training.
Confirmation
*
I have read and accept the ASSUMPTION OF RISK AND WAIVER OF LIABILITY
ASSUMPTION OF FINANCIAL RESPONSIBILITY
I understand that by agreeing to a payment plan or completing an online class registration I have committed to the full length of the training program as described. I understand that I am responsible for payment in full regardless of whether or not I choose to complete the training program.
Confirmation
*
I have read and accept the ASSUMPTION OF FINANCIAL RESPONSIBILITY
ASSUMPTION OF CLIENT RESPONSIBILITIES
I acknowledge that I am expected to attend all sessions of the training course program I hereby now sign up to complete. I recognize that two (2) absences will result in my pet not graduating from the course unless the trainer and I are able to negotiate a makeup session. I understand that I am not entitled to said makeup session, and that these special sessions are provided only at the discretion of the trainer. I understand that I may be charged an additional $32.00 per makeup session. I acknowledge that I am responsible for completing all homework assigned by the trainer during the service period including but not limited to reading the electronic workbook in full and engaging in regular practice sessions with my pet. I commit to continue the behavioral structure outlined by the training program after service period ends in order to maintain effectiveness of training. I recognize that CaninePhD is not responsible for lapses of learned behavior during or after the service period. I acknowledge that the trainer will be in touch with me by email throughout the course and that it my responsibility to answer these communications promptly during the service period. I understand that additional service, including but not limited to further communication with trainer by email or other means and extra one-on-one sessions, is available for purchase from CaninePhD, should I need assistance maintaining dog behavior changes, in the event of need for re-training, or to continue the training program for further skills building. I agree to discuss any concerns or complaints with the trainer directly. I agree to make any formal complaint within 48 hours after the end of the service period.
Confirmation
*
I have read and accept the ASSUMPTION OF CLIENT RESPONSIBILITIES
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