***PLEASE NOTE: We are currently booking 2-4 weeks in advance.*** Client Name (required) Street Address City, State, Zip Phone Number Email Address (required) Emergency Contact Name Emergency Contact Phone Number Dog Name Dog Breed and Age Dog's Approximate Weight Where did you get your dog? How long have you had your dog? Vet Name Vet Phone Number I authorize K9 Solutions to take my pet to the above-named veterinarian for veterinary care if, in their opinion, care is needed and I will be responsible for payment for treatment. If it is an immediate emergency and my regular clinic is not open or it is a matter of life or death of the pet, I give K9 Solutions of Central North Carolina the authority to take my pet to the nearest emergency clinic and I assume all financial responsibility for any bills incurred up to the amount authorized below. I also understand that K9 Solutions of Central North Carolina will be released from all liability related to the treatment, expense, or loss of my pet. I Agree I authorize K9 Solutions to approve treatment up to: (provide $ amount) Is Your Dog Spayed/Neutered? —Please choose an option—YesNo Date of Last Rabies Shot Date of Last DHLPP Vaccine Date of Last Flea Prevention Medicine (*If fleas are found while your dog is with us, we will treat the dog at the owner's expense unless directed otherwise) Date of Last Heartworm Prevention Medicine Is your dog on any medications currently? If yes, provide name and dispensing instructions. I authorize K9 Solutions to dispense medications as directed above. I Agree 1. Goal of Training —Please choose an option—Basic Obedience/MannersHousetrainingLoose Leash WalkingEliminate AggressionOvercome FearsControl Energy/Self ControlResource GuardingDog-Dog InteractionDog-Cat InteractionDog-Kid InteractionJumping on You/GuestsSeparation Anxiety/General AnxietyMouthing/NippingOther: Explain in 'Additional Notes for Your Trainer' Below 2. Goal of Training —Please choose an option—Basic Obedience/MannersHousetrainingLoose Leash WalkingEliminate AggressionOvercome FearsControl Energy/Self ControlResource GuardingDog-Dog InteractionDog-Cat InteractionDog-Kid InteractionJumping on You/GuestsSeparation Anxiety/General AnxietyMouthing/NippingOther: Explain in 'Additional Notes for Your Trainer' Below 3. Goal of Training —Please choose an option—Basic Obedience/MannersHousetrainingLoose Leash WalkingEliminate AggressionOvercome FearsControl Energy/Self ControlResource GuardingDog-Dog InteractionDog-Cat InteractionDog-Kid InteractionJumping on You/GuestsSeparation Anxiety/General AnxietyMouthing/NippingOther: Explain in 'Additional Notes for Your Trainer' Below Additional Notes for Your Trainer Date/Timeframe You Would Like to Start Training What is your availability for us to pick up your dog and do your consults? —Please choose an option—Weekdays - DaytimeWeekdays - EveningWeekdays - AnytimeWeekends - DaytimeWeekends - EveningWeekends - AnytimeAny day/timeOther: Explain in 'Other Availability' below Other Availability: Let us know any additional times/days you are available What kind of results are you expecting from Training Camp? How Often Does Your Dog Eat? —Please choose an option—One in MorningOnce in EveningTwice a DayThree Times a Day How Much at Each Meal? Additional Notes on Food Routine (eats in the crate, sits for food, any food allergies? etc.) What type of Chewies/Treats Do You Give Your Dog? Is your dog crate trained? —Please choose an option—YesNo Where Is the Dog Kept When Alone/Unsupervised? —Please choose an option—Wire CratePlastic CrateGated Room/AreaFree Roam InsideFree Roam In Fenced YardNone of the Above Do you have a fenced-in yard? —Please choose an option—YesNo Home/Work Routine —Please choose an option—Work Full-Time Outside of HomeWork Part-Time Outside of HomeFull-Time in Home Is The Dog Housetrained? If so, how reliable? Explain. How does your dog do with other dogs? —Please choose an option—IndifferentReactive/AgressiveFriendlyTOO FriendlyNever Been Around Other Dogs How does your dog do with Kids? —Please choose an option—Very PoliteNo Exposure to KidsCan be too RoughNeeds to Learn Proper MannersScared of Kids Does your dog live with kids? —Please choose an option—Yes, kid(s) under 5 yearsYes, kid(s) 5-13 yearsYes, kid(s) over 13 yearsNo How does your dog do with cats/small animals? —Please choose an option—Never seen oneIndifferentMight eat one...Likes to play/chase How often do you have guests over to your home? —Please choose an option—Hardly EverA couple of times a monthOur door is always open! Your dog's energy level —Please choose an option—Couch PotatoAverage EnergyAthleticEnergizer Bunny What kind of activities do you currently do with your dog on a regular basis and how often per day or week? (leisurely walks, fetch, couch cuddling, long walks, runs, dog park, hikes, dog sports, etc.) How did you hear about Training School? Would you be interested in following us on Facebook? Click "LIKE" from our home page! May we have your permission to use class/consult photos and/or videos in our marketing program? —Please choose an option—YesNo I understand that training is not without risk to my dog. I hereby waive and release K9 Solutions of Central North Carolina LLC, its officers, employees, owners, members, contractors, and agents from any injury or damage resulting from the action of the dog, and I expressly assume the risk of any such damage or injury while attending any training session, or while on the training grounds or the surrounding area thereto. In consideration of and as an inducement to the acceptance of my application for training I hereby agree to indemnify and hold harmless K9 Solutions of Central North Carolina LLC, its officers, employees, members, contractors, agents from any and all claims, or claims by any member of my family or any other person accompanying me to any training session or while on the grounds or surrounding area thereto as a result of any action of any dog, including my own. I Agree Δ Like this:Like Loading...
