Training/Intake Form

Owner Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Info (Name, Phone Number)*

Does your emergency contact have permission to make medical decisions if you cannot be reached?*

YesNo

What is your availability for in person lessons?*

Weekdays daytimeWeekdays eveningWeekends daytimeWeekends evening

How did you hear about us?*

Name *

Breed/Mix/Best Guess*

Weight*

Date of Birth/Best Guess*

Sex*

Intact MaleIntact FemaleNeutered MaleNeutered Female

Where did you get the dog and how long ago (if breeder which one, if rescue organization which one etc)?*

Vet Information (Name, Phone Number, Address)*

oPlease Upload Latest Vaccination Records (you may send separately if needed)

Is your dog on flea/tick/heartworm medication?*

Yes, bothYes, flea and tickYes, heartwormNo

What food do you feed? *

How much food do you feed per day (please answer in US cups measurement)? *

How often do you feed your dog?

Does your dog finish all of his/her food at meal times?

Does your dog have any allergies? If so, what?*

Does your dog have any medical conditions or are they on any medications?*

How does your dog behave at the vet, how do they behave at the groomer?*

How would you describe your dog?*

What is your favorite thing about your dog?*

What are the most frustrating behaviors your dog displays?*

How many people in the home? (dogs, pets, kids) Are there any issues with anyone?*

Is anyone afraid of the dog? If so, who?*

If your dog does something you disagree with, how do you address it? Is this consistent with everyone in the household?*

Has the dog ever bitten or snapped at anyone for any reason? (human or dog)*

Yes, humanYes, dogBothNo

If yes, please detail (or write N/A)*

Does the dog growl if you take away food or toys?*

YesNoSometimes

Is this the first time you're seeking help from a trainer for your current dog?*

YesNo

If you've already worked with a trainer, what tools/techniques did they teach you and were they effective? (Write N/A if you answered no above)*

How does your dog behave around other dogs? (bold, friendly, reactive, timid etc)*

Do you take your dog off leash?*

YesNo

What do you do to exercise your dog?*

To socialize your dog, what have you exposed them to? (different sights, sounds, areas etc)*

What do you use to walk your dog?*

Has your dog ever worn a bark collar or invisible fence collar?*

Do you crate your dog?*

How does your dog behave in a crate?*

CalmHe/she barksHe/she tries to escape/bites crateI don't know

Is your dog allowed on furniture?*

YesNoSometimes

Does your dog display any of the following behaviors?*

How is your dog when traveling in the car (calm, anxious etc)? Are they crated or free?*

Has your dog been boarded before?*

YesNo

If yes, where did they stay and did you get any feedback? (Write N/A if you selected no above)*

Has your dog been to dog parks or doggy daycare?*

Dog ParksDaycareBothNeither

Is your dog stressed by (please select all that apply)*

What do you expect you and your dog to get out of training with us? Any goals?*

Training Goals (select all that apply)*

Are there any other commands or behaviors you want your dog to learn to fit your lifestyle better or improve quality of life with them?

Please list any/all commands you currently use with your dog along with the meaning of the command. Example: (Heel- means dog walks by my side and automatically sits when I stop walking)

Tell us about your daily routine with regards to your dog (potty schedule/feeding/walks/play time/ect).

Tell us about any boundaries or rules you currently implement with your dog at home. (Examples: must sit before putting down the food bowl or exiting the front door, not allowed on furniture, ect).

On a scale of 1-10 how motivated are you to make or see change? (1=not very motivated, 10= very motivated)*

How fast do you expect to see change?*

Anything you want to add or would like us to know?

What training programs are you interested in?*

Board and train - obedienceBoard and train - personal protection/sportBoard and train - behavior modification (aggression/reactivity)Private lessons - obediencePrivate lessons - personal protection/sportVirtual Private Lessons - obedienceVirtual Private Lessons - sportGroup Training

How soon are you looking to begin training?

ASAPWithin a few weeks to one monthA few months from now6+ months from now

I acknowledge that Quantum Canine uses a variety of training tools including but not limited to; clickers, slip leads, prong collars, & remote collars*

I acknowledge and am good with using these tools once I have been properly trained how to use themI am uncomfortable with using one or more of these tools

If you are uncomfortable using any of the tools listed above, please elaborate on which ones and why*

If Quantum Canine believes that you are using these training tools incorrectly, we reserve the right to take back tools that were provided to you by us*

I acknowledge

REFUNDS AND PAYMENT This contract is entered between the OWNER and Quantum Canine. For the consideration described herein, Quantum Canine agrees to provide the services indicated below and according to the signed proposal for OWNER and OWNER'S dog. The OWNER understands and agrees that, should OWNER fail to cooperate fully in completing the OWNER training sessions Quantum Canine can not and does not assume or accept responsibility for the behavior or performance of the dog after it has been returned to the OWNER. Seven days notice is required if owner can not make an appointment (LESSON) that is booked. One month notice is required if an owner decides to cancel a board-and-train. If 3-weeks notice is given, owner is responsible to cover 25% of board-and-train cost not including the deposit already paid. If 2-weeks notice is given, owner is responsible to cover 50% of board-and-train cost not including the deposit already paid. If 1-week notice is given, owner is responsible to cover 75% of board-and-train cost not including the deposit already paid. If less than 1-week notice is given, owner is responsible for paying 100% of the board-and-train cost. Quantum Canine may, at its sole discretion, consider applying services paid and not recieved in the aforementioned cases to new booking dates for emergencies. If non-sufficient notice is given to Quantum Canine, as deemed previously in this paragraph, and OWNER does not show up for a booked appointment, OWNER is responsible to pay 100% of booked or scheduled services. All deposits paid are non-refundable and all equipment purchased is nonreturnable. If OWNER becomes disruptive or difficult to work with OR fails to follow the training program and does not do the homework Quantum Canine at its sole discretion may limit, suspend or terminate the training program without forgiveness of any previous payments. The OWNER represents that he/she is the legal OWNER of the dog described above. That the dog is free and clear of any mortgage or other encumbrance; that the dog has not been exposed to distemper, rabies, or parvo within the past thirty (30) days; That the dog has up-to-date vaccinations as shown above. Should collection efforts become necessary, Quantum Canine may recover all costs of collection, including reasonable attorney fees. If any delay or interruption in training is the fault of, or at the request of Quantum Canine, OWNER shall NOT be charged for any such delays or interruptions.

IN HOUSE BOARDING / TRAINING Quantum Canine agrees that, while the dog is on its premises and under its control for training, Quantum Canine will exercise the upmost diligence and care to protect the health and safety of the dog. However, OWNER agrees Quantum Canine has no liability for loss or damage to the dog or the OWNERS property resulting from fire, disease, illness, virus, escape, theft, death, or other unavoidable causes. OWNER agrees to the transport of the dog by Quantum Canine and releases Quantum Canine from liability as a result of transport. If the dog shows evidence of a medical problem while under the care and control of Quantum Canine, Quantum Canine shall have the right to take such measures as deemed necessary, without being liable to the owner, for the health and safety of the dog, including the right to administer medication or obtain an evaluation of treatment by a veterinarian of Quantum Canine’s choice. If, in the opinion of Quantum Canine staff or the veterinarian selected by the Quantum Canine, the cost of treatment will exceed the amount of sixty dollars ($60.00), a reasonable attempt will be made to contact the owner. In the event that the owner cannot be contacted, Quantum Canine or the Veterinarian selected by Quantum Canine may, without the liability of the OWNER, provide such emergency treatment as is deemed necessary to preserve the life and health of the dog. The OWNER shall pay the cost of all treatment provided for in this paragraph, in addition to the contract price prior to the dog being picked up by the owner. If, at completion of the agreed training time, the dog is not picked up by the owner and payment of all charges made in full, including applicable medical, veterinarian charges as provided herein, Quantum Canine shall notify the OWNER by certified mail at the address shown above that the dog will be held for an additional seven (7) days following the date of mailing the notice. At the end of the seven-day period, if there is no response from the owner, the dog may be sold at public or private sale. The proceeds from such shall be first applied to the charges of Quantum Canine, and the balance, if any, shall be donated to a local charity or non-profit group of Quantum Canine’s choice.

TRAINING LIABILITY Quantum Canine is NOT Liable For Dog's Performance after the dog has been returned to the owner by Quantum Canine and is off Quantum Canine’s premises, Quantum Canine cannot and does not accept any responsibility for the illness, injury, or death of the dog or any other person or animals, or damage to any property caused by the dog. Although Quantum Canine will use all reasonable care to train OWNER'S dog, Quantum Canine cannot guarantee that the dog will respond adequately to commands at all times. OWNER agrees that Quantum Canine will not be liable for any damage or loss resulting from the dog's failure to respond to any commands or behaviour modification for which Quantum Canine trained the dog. Should the dog injure any person, or should the dog's failure to respond to any commands result in damage to the property of any person or any person (including the OWNER), OWNER agrees to absolve Quantum Canine from any and all obligations and to pay any such damage to such person. OWNER further agrees to hold Quantum Canine free from any and all such claims.

In this contract, Quantum Canine agrees to provide training services for the signed OWNER (client). Quantum Canine agrees to care for the health and safety of the dog at our best ability, and to train the dog to its fullest potential within the program limitations or allotted timeframe. It is important to note that while Quantum Canine offers lifetime support for training packages, the behavior of a living animal cannot ever be 100% guaranteed and care must be taken to ensure the dog is set up for success after program completion. Quantum Canine agrees to continue lifetime support for applicable programs (see brochure) until the OWNER is satisfied, but cannot be held liable for carelssness on behalf of the OWNER after the dog is returned to the OWNER that results in injury or death to the dog.

IMAGES Quantum Canine trainer may photograph and or video tape training sessions for future use in training, advertising or other purposes.

OWNER consents to Quantum Canine’s use of images of OWNER and pet in such manner.

SPECIAL NOTES:*In order to book training, we require a non-refundable deposit for the chosen training package* Payment must be recieved in full before program completion.

I acknowledge that in order for my dog to be accepted at pick up/drop off for board & trains they must have a collar with tags*

I acknowledge

I acknowledge that by e-signing below I am accepting the above terms and that any questions or concerns I have regarding this Agreement have been addressed to my full satisfaction*

I acknowledge

Print Full Name*

Signature*

Date*

Date

Training/Intake Form

Contact Info

Dog Info

Training Goals and Expectations

Training Contract