Parenting with Pets Registration Form

Parenting with Pets Program Registration
Our Companions Parenting with Pets is on a mission to educate families on pediatric dog bite prevention and how to promote safe and happy relations between family pets and children of all ages. The In-Home Private Training Program is designed to provide comprehensive dog training that fits your family's unique needs whether you are planning for a new baby, looking for new and engaging training techniques, or experiencing concerning behavior in the home.

The program consists of three (3) private sessions. Each session is one-hour in length and conducted by Beth Vincent, Certified Professional Dog Trainer (CPDT-KA) and Family Paws Parent Educator (FPPE). The in-home service area is limited to Hartford, Tolland, North New London, and North Middlesex counties. Zoom available across Connecticut

All Our Companions Behavior Programs follow a Pay-What-You-Can System, where clients can adjust the price of classes based on what they are willing and able to pay.

The suggested price for this program is $275
Client Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you previously attended a Behavior Consult at Our Companions?*

YesNo
What would you like to accomplish/what are your goals for this program? Please list in order of priority.
Dog Information
Dog's Name*
Age*
Breed*
Where did you get your dog?*
How long have you had your dog?*
Is your dog Spayed/Neutered?*

YesNo
Does your dog have any medical concerns, injuries, or allergies that you would like us to be aware of?*

YesNo
If Yes, please explain:
Has your dog previous attended training classes?*

YesNo
If Yes, please tell us where, when, and a brief description of what you learned.
What skills does your dog already know?*
Does your dog have a history of fear, reactivity, or aggression?*

YesNo
If Yes, please explain.
Family Information
Names and Ages of adults living in the home:*
Names and Ages of children living in the home:*
Are there any other animals in your home?*

YesNo
If Yes, please list Names, Species, and Ages.
Rabies Vaccination Agreement
Every dog participating in training programs at Our Companions Animal Rescue (OCAR) must be up-to-date on their Rabies Vaccination in accordance with Connecticut State Law. All clients are required to submit proof of vaccination before your first scheduled session.
Is your dog currently Up-to-Date on their Rabies Vaccination?*

YesNo
If yes, what is the expiration date? *
Photo Release
Photos and videos are often taken of participants and their dogs during training programs at Our Companions Animal Rescue and are often used in our social media posts, newsletters, promotional materials, websites, etc. It is important to us that we respect the safety, security, and personal rights of all of our community members.

Yes, I grant permission for OCAR to take photos/videos of myself, my pet(s), and property to use and publish these materials in both print and electronic media.No, I do NOT grant permission for OCAR to take photos/videos of myself, my pet(s), and property to use and publish these materials in both print and electronic media
Signature*
Print Name*
Date*

MonthDayYear
Agreement to Hold Harmless
In consideration for participation in the training offered by Our Companions Animal Rescue (OCAR), I hereby assume all responsibility for any claim, loss or damage, of whatever kind or nature, whether to person or property, arising out of or related to this training. I further agree that I will hold OCAR, its officers, directors, trainers, volunteers, agents and members harmless and defend them from any and all liability for any injury, claim, damage or loss, of whatever kind or nature, whether to person or property, arising out of or related to this training. I agree to indemnify OCAR, its officers, directors, trainers, volunteers, agents or members who might be the subject of any claim, suit, loss or damage caused in any way by any act or negligence on my part or on the part of my dog during the Training Program.

I acknowledge that while OCAR may facilitate and sanction this training, OCAR does not have and does not exercise control of the conduct of my dog(s). I further recognize that OCAR is providing this training as a community service and utilizes volunteer trainers with varying levels of training experience. I also understand that the degree to which a dog is successfully trained is a function of the interest, commitment, and cooperation of the owner. I acknowledge and agree that there is no guarantee that my dog will achieve the desired level of training, despite the best efforts of the instructor. I also acknowledge that all information I have provided is factual, complete, and honest.
Signature*
Print Name*
Date*

MonthDayYear
Payment Information
My Products
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Parenting with Pets Registration FeeProgram Fees can be adjusted using the Pay-What-You-Can drop down below.
$275.00

Donation (Optional)Add a donation to support our canine behavior programs and help other pet families in need.
$25.00 Donation Amount

Total

$0.00
Should be Empty:

Parenting with Pets Program Registration

Client Information

Dog Information

Family Information

Rabies Vaccination Agreement

Photo Release

Agreement to Hold Harmless

Payment Information