Puppy Class Consent Form

Owner Name*

First NameLast Name

Owner Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Pet (patient) Name*

Puppy's full name as you wish to appear on graduation certificate*

DOB or Age of Pet:*

Breed of Pet*

Color of Pet*

Sex of Pet*

MaleFemaleMale/neuteredFemale/spayed

Approximate Weight of Pet*

Primary Veterinary Practice Name and Contact information*

Image of Pet*

For ease of recognition, please upload a picture of your pet. This image will be used exclusively in your pet's chart for identification purposes.

I   First Name*   Last Name*   , the undersigned owner or agent, hereby consent and authorize staff of the Animal Behavior Wellness Center to manage my puppy during puppy classes.
Initials :   Initial Here*

I acknowledge that classes are to take place under the supervision of ABWC trainers as agreed upon, and assume all risks in connection therewith, including damage or injury resulting from any actions of my animal. The trainers are to use all reasonable care and precautions, but it is understood that I assume all risks except negligence on their part.
Initials :   Initial Here*

I acknowledge that if my puppy is showing any sort of gastrointestinal or upper respiratory illness, including vomiting, diarrhea, lack of appetite, lethargy, coughing or sneezing, I am not to bring them to class until they have been deemed healthy and cleared by my family veterinarian. I understand that all necessary precautions are taken by ABWC to prevent illness spread among puppies and that surfaces are regularly disinfected as such. However, should my puppy be diagnosed with an infectious illness, I do not hold ABWC liable for anything associated with this, as reasonable precautions are being taken.
Initials :   Initial Here*

I acknowledge that deposits and payments are non-refundable, and that make-up classes/credit will not be provided in the event of absence from class.
Initials :   Initial Here*

I grant permission to the Animal Behavior Wellness Center, hereinafter known as “Media,” to use my pet’s image (photographs and/or video) for use in Media publications to include, but are not limited to, educational material, client resources, general publications, social media, etc.

I understand that my name (first and last) will never be used in association with these images or videos, but that my pet's name may be used as an identifier.

I hereby waive any right to inspect or approve the finished photographs or finished matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image.

Media Release*

ApprovedDeclined

Signature*

Date*

Date

Puppy Class Consent Form

Puppy Information

Media Release