Owner Contact Information

Your Name Today's Date

Address

City, State, Zip

Phone No. - Home Work Cell

E-mail

Dog Information

Dog's Name Breed

Sex Neutered? Date of Birth

Where did you get your dog?
Breeder Shelter Rescue Other (where?)  

Is your dog on any medication other than heartworm preventative or tick and flea protection?
No Yes    If yes, what conditions are being treated?

Does your dog have any known allergies?
No Yes   If yes, what are they?

Has your dog ever bitten a person or dog?
No Yes   If yes, please describe the incident(s)

Any prior obedience training?
No Yes   If yes, equipment used

What equipment do you currently use to control your dog? Buckle collar Head halter Body harness Pinch (prong) collar Choke chain E-collar

Check all that apply:

General

Friendly with all people
Friendly with all dogs
Likes to play with toys
Likes food treats
Is crate trained
Is comfortable being patted and handled

Behavior Problems Needing Assistance

Fearful of people
Other fears (describe below)
Barks or growls at family members
Barks or growls at strangers in the home
Barks or growls at strangers outside the home
Barks, growls or lunges at unfamiliar dogs
Fights with other dogs in the household
Protects the food bowl, toys, bones or spaces from other dogs
Protects the food bowl, toys, bones or spaces from people
Urinates when excited or when greeting
Vocalizes excessively when left alone
Has difficulty relaxing and being still/hyperactive
Has housebreaking issues
Destructive (describe below)
Jumps on people
Pulls excessively on leash

Other:

Other reasons for requesting services such as general obedience, new dog, etc.:

Services Requested:
In-Home Training
Private Lessons
Not sure

Release and waiver of liability: If above named dog causes property damage or bites or anyway injures any person, dog or animal during or after the consultation, then Client agrees to pay all resulting losses and damages suffered or incurred, and to defend and indemnify Trainer, Trainer's agents and Savvy Dogs, LLC from any resulting claims, demands, lawsuits, losses, costs or expenses, including attorney fees. If dog is injured in a fight or any other manner during or after the consultation, client assumes all risk and agrees that Trainer, Trainer's agents and Savvy Dogs, LLC should not be held responsible for any resulting injuries, losses, damages costs or expenses.

By submitting this form you are agreeing to the terms of this release waiver.