New Puppy Client Form

Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail*

Preferred Method of Contact

PhoneEmailTextOther

Dog's Name*

Dog's Primary Breed

If unknown, your best guess is ok

Dog's Weight

Date of Birth (approximate ok if rescue):

Date

Spayed or Neutered

YesNoNot Yet

Is your dog up to date on vaccinations?

YesNo

Does your dog have any allergies to any specific foods or treats?*

What Classes Would You Like to Enroll

Puppy Socials at Doggie Zen Den in Plano at 7:00 pmManners 101 starting 10/8 @ Doggie Zen Den at 7 pmAmateur Agility Fridays @ All Fur Fun in Addison at 10 amAmateur Agility Fridays @ All Fur Fun in Addision at 11 amPattern Games for Distracted and Reactive Dogs at Doggie Zen Den in Plano at 8:00 pmCanine Good Citizen Preparation & Test

Requested Start Date

Date

If you have any notes about start times, feel free to leave them here!

Please list your goals for your dog

Please list goals, and feel free to include any other information you would like to share with ourr group class team.

ASSUMPTION OF RISK. The undersigned (“you” or “Participant”) acknowledges that he/she is voluntarily participating in dog training provided by Wiggle Butt Academy, LLC. with knowledge of the potential dangers. Participant represents that he/she is the owner or guardian of the dog(s) identified in this Agreement. You acknowledge that dogs are unpredictable animals with their own will and drives, and therefore, regardless of training, handling, or environmental circumstance, Wiggle Butt Trainers cannot protect against every potential injury, risk or accident to you, to other persons participating in the training or on the property where the training is taking place, or to dogs. These may include dog attacks, dog bites and the responsive actions and complications that arise from them, and you understand and acknowledge that such risks are inherent and cannot be eliminated. This Agreement is intended to shift the risk of participating in dog training to you. Do not sign it unless you are willing to assume the risk to yourself, your dog, and others accompanying you of your participation in dog training, including the associated risks of bodily injury, death or property damage while participating in the dog training and related activities on the property of Wiggle Butt Trainers, in your own home, or in a public space.

RELEASE OF LIABILITY. Participant agrees that in consideration for being permitted to participate in dog training provided by Wiggle Butt Academy, and/or to use any of Wiggle Butt Academy facilities in connection with dog training, Participant, for himself/herself, and his/her heirs, next of kin, executors, and personal representatives (collectively, “Releasors”), assumes the entire risk associated with participating such an activity and waives, releases, discharges and covenants not to sue Wiggle Butt Academy, its directors, officers, members, managers, employees, agents, sponsors, organizers, volunteers or other representatives, their successors and/or assigns (collectively, “Releasees”), from any and all liability to Releasors for any loss, harm, damage, claim, injury (including death) or accident to the person or property of Participant, Participant’s dog, and any other persons accompanying Participant at the dog training, including any minor children, arising out of or related to participating in dog training or using any facilities or equipment of Wiggle Butt Academy, even if caused by any negligent act or omission of Releasees. Nothing herein is intended to release Releasees from any harm, injury, claim or damage caused by intentional, wanton or reckless misconduct

INDEMNIFICATION. You agree that you are and will be responsible for your conduct and the conduct of your dog and others accompanying you (including minor children) at all times. You agree to indemnify and hold harmless Wiggle Butt Academy, its directors, officers, members, managers, employees, agents, sponsors, organizers, volunteers and other representatives (“Nicole Kohanski”), from any and all claims of injury (including death), loss, cost, expenses, or damage to persons, dogs, or property caused by the acts or omissions of you, your dog, and any other persons accompanying you, including any minor children, during the course of training or related activities, as well as by the conduct of your dog under your own care as a result of following training instructions. This provision applies whether the claims are made by you, members of your family, your accompanying guests, Wiggle Butt Academy Personnel, or third parties.

NO GUARANTEE OF RESULTS. You recognize that the role you play in your dog’s learning process is integral to achieving desired results. You acknowledge and agree that there is no guarantee that your dog will achieve the desired level of training, despite the best efforts of Wiggle Butt Academy. You further understand that the recommendation of any other product or service by Wiggle Butt Academy is not a guarantee of satisfaction with that product or service.

PHOTO RELEASE. By signing below, you give Wiggle Butt Academy permission to publish in print, electronic, or video format the likeness or image of you and/or your dog. You release all claims against Wiggle Butt Academy with respect to privacy rights, publicity rights, copyright ownership and publication, including any claim for compensation related to use of the materials.

SAVINGS CLAUSE. You expressly agree that the foregoing assumption of risk, release, waiver, and indemnity provisions are intended to be as broad and inclusive as permitted by applicable law, and that if any portion thereof is held invalid, you agree that the remaining provisions will continue in full force and effect.

KNOWING AND VOLUNTARY EXECUTION. By signing below, you declare that you are at least 18 years of age and competent to sign this Agreement. You acknowledge that you have carefully read this Agreement, understand its contents, and agree to be bound by its terms. You specifically understand that this Agreement includes an assumption of the risk of Wiggle Butt Academy’s negligence and a release of Wiggle Butt Academy’s liability.

BILLING POLICY. Wiggle Butt Academy will process payment for services at the completion of service with the exception of services that require a deposit (which will be due and payable at time of invoice). All board and train programs must be paid in full prior to pick up. We require a valid credit card on file which may be input and/or changed at any time via our portal:

https://wigglebuttplace.portal.gingrapp.com/

If the system requires a client portal code, it is 259531. Invoices and prior services rendered may be accessed via the portal. By signing this form, you authorize automatic payment on services rendered.

Signature*

Name

First NameLast Name

Date Signed

Date

About Your Dog

Classes

Group Class Waiver and Release

Signature and Date