Your Name:

Address:

City: State: Zip Code:

Phone (day): Phone (night):

Email:

Vet’s name: Vet’s phone number:

Dog’s name: Dog’s birthday: Breed:

Neutered? yes ... no

Does your dog have any medical problems?

On any medications?

Where did you get dog? At what age? How long have you had the dog?

Any other training?

What do you want to accomplish in this class?
Goal #1
Goal #2
Goal #3

What concerns do you have about this dog?

Approximate % of time your dog is: ...outside % ...inside % ...alone % ...tied %

Please check anything that applies to your dog:
Growls
Pushy
Excessive energy
Too attached to me
Shy
Bites
Dominant
Mouthy
Fearful
Destructive
Aggressive
Not good with people
Guards food/toys
Won’t listen to me
Noisy
Not good with dogs
Other

Briefly explain anything you have checked:

Indemnity Agreement:

Dog Obedience Academy 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 Dog Obedience Academy 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 Dog Obedience Academy training classes as set forth in this contract. I understand that attendance of dog training classes is not without risk to me, 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 Dog Obedience Academy, 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 Dog Obedience Academy 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.