Behavior Modification

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone*

Please enter a valid phone number.

Home phone*

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Can you receive text on your cell?*

How did you hear about us?

Age group*

How many adults and or children in the home?*

Would you consider yourself?*

Lvivng Arrangements*

How did you hear about us? If referred by friend or veterinarian please specify.*

Have you ever owned a dog? If you have a puppy when was the last time you owned a puppy?*

Have you you trained a dog? Level of success?*

Has your dog had previous training? If so, where and what age?

Have there been any changes in you or your dog's life in the past 6 months?

What do you hope to accomplish in this program?*

Where did you acquire your dog? Age of your dog when you brought it home?*

Please answer all questions- Dog's Name, Breed, Sex, Age, Weight?*

Spayed or Neutered and at what age?*

Are there other animals in the home? If so, type , age and breed?*

Where does your dog(s) sleep at night?*

Do you use a crate? If not please explain in detail.*

Is your dog house trained, crate trained? Explain if there is a problem*

How many hours is your dog left alone during the day if you are working? If left alone in a crate how many hours? *

Please answer all quetions. Name of food? How often you feed your dog? Do you free feed (leave food down all day) or scheduled feed?*

Type of exercise your dog gets on a daily? How often do you walk your dog and for how long?*

Has your dog been introduced to a leash and collar? If so what type of collar and leash do you walk your dog on? What results do you have with the leash and collar>

Does your dog have any disabilities? If so, please explain*

Does your dog engage with in play with other dogs?*

What correction techniques have you tried onyour dog and the effect it had if any?*

Behavior Problems. Check all that apply.*

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Current on vacinations? What type of vaccinations has your dog had?*

If on medications, please list.*

Any previous obedience training? Location? Level of success?*

What commands does your dog respond to?*

Which family member has the best control?*

Is your dog leash trained? Indicate type of collars used?*

Has your dog developed any unexplained behaviors? If so when did this take place? Explain type of behavior.*

Do you know if your dog (if adopted or rescued) had any type of abuse? Explain?*

Is your dog afraid of fireworks, lightening or thunder?*

Do you know if your dog has beed exposed to cats or other type of animals? If so, what is the reaction to them? Type "unknown" if you do not know.*

What is your dogs reaction to departure during the day or evening?*

Does your dog exhibit cowering, ears back, tail tucked, retreats, pacing, hides? If so, explain when and where this happens.*

Does your dog resource guard humans, food, bones, toys, furniture? In what instances does this happen? If so, what do you do to correct?*

Does your dog exhibit any type of agression, if so explain in detail.*

Does your dog have a reaction if you grab it's collar? If so, what does it do? How do you handle the response?*

Does your dog have a problem if you touch it on the head or around it's face with your hands? Does your dog go after your feet and try to bite them?*

Have you ever muzzled your dog for safety reason? If your dog has bitten anyone do you have a problem using a muzzle?*

Has anyone in your family or your friends been bitten by your dog? If so, please explain in detail.*

Is anyone afraid of your dog?*

Has your dog ever been reported to animal control for biting a human or another animal?*

Upload your dog(s) vaccination record. If you cannot upload I will get a copy at our appointment.

WAIVERS ******General Policy******

1. DePaul K9 Academy will endeavor to create as safe environment as possible for the training/boarding care of the dog(s) identified as (the dog), and will offer a safe, sound and responsible training, care and post-boarding training instructions.
2. Owner agrees, however, that all animals may exhibit unpredictable behaviors and that DePaul K9 Academy will not be liable for the actions of the dog that are outside the control of DePaul K9 Academy training
3. Owner agrees that the recommendation by DePaul K9 Academy training of any product or service is NOT a guarantee of performance or Owner's satisfaction with that product or service. Owner(s)understands the training is not guaranteed when not in the prescence of DePaul K9 Academy Training. The follow-up and instruction must be done daily by the owner to ensure the re-inforcement of the work and techniques used to train the dog when dog was with trainer. Owner undertsands fully the dog may revert back to old behaviors, if owners do not change the energy and behaviors of themselves at home.
4. DePaul K9 Academy agrees to indemnify and hold Owner harmless from and against any claims of injury, expense, costs, loss of damages caused by the gross negligence or willful misconduct of DePaul K9 Academy training while the dog is in sole custody, care and control of DePaul K9 Academy training.
5. Owner fully understands the tools and techniques used to train/modify the behavior of their dog and agrees to the tools/ techniques which include leash, prong collar, bark collar, remote training collar, slip lead, Pet Convincer, muzzles, flat buckle collar, gentle lead, martingale collar.

****Payment and cancellation Policy****

Payment Policy: Payment of 1/2 to be paid at time of booking your board and train program. All other programs are to be paid in full at time of booking with the exception of the board and train programs.

1.If we have scheduled you for a one,two or three week board and train and you fail to notify us within 2 weeks of your scheduled board and train NO REFUNDS are issued.

2.If you have not notified us with in 48 hours of your private lessons you will be responsible for the consultation rate of $190.00. If you choose to cancel the paid scheduled sessions of your private lessons, we will freeze your session and reschedule you when it is more convenient. NO refunds will be given due to the time that was scheduled with the trainer. If there is an unforseen circumstance where you cannot continue to meet for sessions a partial refund may be refunded at the discretion of the trainer.

3. If the client chooses NOT to continue training after receiving approximately 50% of services, a refund WILL NOT be issued. If the trainer feels that the client will not listen to training advice, observes any harm given to the dog or will not follow instructions, Depaul K9 Academy can at sole discretion, choose to cancel the training contract and a partial refund will be discussed according to which program you were enrolled in.

AGREEMENT TO HOLD HARMLESS, WAIVER AND ASSUMPTION OF RISK

I understand that attendance of a dog obedience training class is not without risk to myself, members of my family or guests who may attend, or my dog, because of some of the dogs to which I will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest amount of care. Client understands a muzzle may be needed to prevent possible bite, if dog is deemed to have any type aggression problem or bite history.

I hereby waive and release Carol DePaul, DePaul K9 Academy hereinafter referred to as the "Training Organization", its employees, officers, members and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any training session, or any other function, of the Training Organization, or while on the training grounds or the surrounding area thereto.

In consideration of and as inducement to the acceptance of my application for training membership by this Training Organization, I hereby agree to indemnify and hold harmless this Training Organization, its employees, officers, members and agents from any and all claims, or claims by any member of any family or any other person accompanying me to any training session or function to the Training Organization, or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own.

Photos/Video Release (All Clients)

I hereby assign, grant and authorize DePaul K9 Academy the right and permission to use, reproduce and distribute, sale, copyright, exhibit, broadcast and publish the photograph(s), film(s), videotape(s), audio and video recording(s), electronic representations(s) and/or sound recording(s) made of me and /or my dog(s) at any time during the training and/or boarding of my dog(s) by DePaul K9 Academy. I specifically waive any right to any compensation I may have for any of the foregoing.

I have read and understand the terms and agreement stated in such contract. I understand that by typing my name and clicking SUBMIT I am electronically signing this document.

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Behavior Modification

Dog Information

Veterinary Information

Training Information

Behavior Information