Private Consult Questionnaire

Availability (required)
—Please choose an option—DaytimeEveningWeekends

First Name (required)

Last Name (required)

Other Attendees

Home Phone

Cell Phone (required)

Email (required)

City (required)

Zipcode (required)

Breed (required)

Age (required)

Age in Months or Years (required)
—Please choose an option—MonthsYears

Gender (required)
—Please choose an option—MaleFemale

Weight (required)

Spayed/Neutered (required)
—Please choose an option—YesNo

Description of behaviors to be addressed (please include any aggressive issues) (required)

Vet Organization Name (required)

Doctor Name (required) (required)

Doctor Phone (required)

Who referred you to us? (required)

Where did you acquire your dog? (required)

Waiver, Assumption of Risk, and Agreement to Hold Harmless I understand that dog training 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) will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest amount of care. I hereby waive and release K9 Solutions of Central North Carolina, 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, its officers, employees, members, contractors, and 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. Terms of Service 1. The information filled out on this application is accurate and complete. 2. All owners must clean up after their dogs when out in public. 3. All dogs must remain on a leash when in public. 4. Anyone under 18 training a dog must have a parent or responsible adult in attendance. By typing my name below I agree to the above terms of service. (required)

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