Dolfly Training Intake Form

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Emergency Contact Number*

Please enter a valid phone number.

Who were you referred by? (N/a if not applicable)*

Photo of Your Dog*

Dog's Name*

Sex*

Spayed or Neutered?*

Weight*

(Approx.) Date of Birth*

Dog's Health Records*

List all that apply to your dog.*

Explain*

What are your goals for your dog?*

Does your dog have any allergies, sensitive skin, take any medications, etc? List all that apply here. *

List any prior injuries or limitations your dog may have.*

Other Pets in Household

Additional Terms Including Waiver of Liability and Releases
Blake Coltham and Dolfly Canine Training & Grooming LLC (collectively “Dolfly Canine Training & Grooming LLC”) will endeavor to create as safe an environment as possible for the training and boarding care of your dog and will offer only sound, safe and responsible training, care and post-boarding training instructions. However, you acknowledge and understand that Dolfly Canine Training & Grooming LLC is not responsible for any unintentional errors, omissions, or incorrect assertions. It is fully understood that various tools and techniques will be used which may include but are not limited to Flat Buckle Collars,Martingale Collars, Slip Collars, Prong Collars, Bark Collars, Remote Training Collars, Rewards (Treats,
Toys), etc.. Further, you the owner will remain responsible for the actions of your dog at all times and hereby agree to indemnify and hold harmless Dolfly Canine Training & Grooming LLC and its employees, agents, and representatives of any and all claims of injury, expense, costs or damages caused by the actions of your dog while under the care of Dolfly Canine Training & Grooming LLC and under your own
care as a result of the care and post-boarding training instructions. It has been communicated to you by Dolfly Canine Training & Grooming LLC and understood by you the owner the inherent risks in owning a dog, including but not limited to the risk of dog bites to the owner or others. As the owner, you acknowledge and understand that there are certain risks involved in pet training, boarding, and care. You release, indemnify and agree to hold Dolfly Canine Training & Grooming and its employees, agents, and representatives harmless from any and all manner of damages, claims, loss, liabilities, costs or expenses, causes of actions or suits, whatsoever in law or equity, (including, without limitation, attorney's fees and
related costs) arising out of or related to the services provided to you and your pet by Dolfly Canine Training & Grooming LLC.

I authorize emergency medical care to be provided for my dog(s) by the below-named veterinarian, or anappropriate alternate to be determined by Dolfly Canine Training & Grooming LLC in the event that my regular veterinarian is not available or that closer care is required. I authorize Dolfly Canine Training &
Grooming LLC to act on my behalf to request veterinary treatment and services when they deem it necessary. I accept full responsibility for charges incurred in the treatment of my dog(s), not to exceed the following amounts for each pet:

Pet name*

Description*

Highest Amount*

I authorize Dolfly Canine Training & Grooming LLC to treat my pet(s) and I will be fully responsible for all fees and charges. Credit Card to be used if I cannot be reached:

Name*

CC#*

Expiration Date:*

Preferred Veterinary Clinic*

Veterinary Clinic Phone Number*

Please enter a valid phone number.

Veterinary Clinic Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Signature*

Date*

Date

Photo/Video Release: I, the Owner hereby assign and grant to Dolfly Canine Training & Grooming LLC the right and permission to use, reproduce, distribute and publish the photograph(s), film(s), videotape(s), audio and video recording(s), electronic representation(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 Dolfly Canine Training & Grooming LLC and I hereby release Dolfly Canine Training & Grooming LLC from any and all liability resulting from such use, reproduction, distribution, and publication. I hereby authorize thereproduction, sale, distribution, copyright, exhibit, broadcast and/or electronic storage of any and all such photograph(s), film(s), videotape(s), audio and video recording(s), electronic representation(s) and/or sound recording(s) without limitation at the discretion of Dolfly Canine Training & Grooming LLC and I specifically waive any right to any compensation for any of the foregoing.

Payment Policy: In order to reserve your dog's Board & Train program, you must pay 50% of the fee. The remainder must to be paid in the full amount prior to or by the start date of your Board & Train. You will receive an invoice for your dog's training program; we accept payments via PayPal, Venmo, Square, or cash.

Cancellation Policy: Deposit is 100% refundable with up to three weeks of notice of cancellation. Training canceled by owner during the training will not be refunded. If the trainer cancels training for any reason, owner will be refunded.

Pick-up/Drop-off Agreement: Board and Train dogs will be picked up & dropped off by the client at a predetermined location. At the drop off session, we will go over what your dog has learned and begin implementing the training into your home and lifestyle. Follow-up lessons are provided after the 3 and 4 week board & train to help ease the transition of your dog back into your home and to help you maintain the high standard for behavior gained in our program. When bringing your dog for a Board and Train, Dolfly Canine Training & Grooming LLC requests the following: Enough food for the duration of your board & train, any medication your dog needs, including flea/tick and/or heart worm (only if they need to be given to your dog while your dog is with us). You may provide additional bedding, water/food bowls, treats, and chews if you so choose.

Upon arrival, your dog must be on a leash/collar setup from which they cannot slip out of when going from your car to the trainer.

Payment Information and Agreement

You understand that the degree to which a dog is successfully trained is a function of the interest, commitment, and cooperation of you, the owner/handler. You acknowledge and agree that there is no guarantee of what my dog will achieve in training based on the instruction given, but that you as the owner/handler of your dog(s) are responsible for teaching and training your dog(s). By typing filling out
and providing your name on the registration form and submitting your application for services, you acknowledge that you have read this “Dolfly Canine Training & Grooming LLC Intake Form and Services Agreement” and agree to its terms. You also acknowledge that all information is complete and accurate
to the best of your knowledge. You further agree that this Agreement has been executed, delivered, and accepted in Virginia, shall be deemed to have been made in Virginia, and, for all purposes, shall be construed in accordance with
the laws of Virginia without regard to conflicts-of-law principles. Any action or proceeding by either of the Parties arising out of or relating to this Agreement or the subject matter described herein shall be brought only in any court located in the state of Virginia, City of Poquoson, or any federal court located in the Commonwealth of Virginia. If any provision of this Agreement, or its application to any person, place or circumstance, is held by an arbitrator or a court of competent jurisdiction to be invalid, unenforceable, or void, such provision shall be enforced to the greatest extent permitted by law, and the remainder of this Agreement, and such provision as applied to other persons, place and circumstances, shall remain in full force and effect. This Agreement shall be binding upon an inure to the benefit of Dolfly Canine Training & Grooming LLC and, to the extent not already included in the parties identified in this paragraph, their officers, directors, employees, agents, legal counsel, heirs, successors, and permitted assigns. This Agreement may be executed in one or more counterparts, including executed copies transmitted by
PDF attachments to an e-mail, each of which shall be deemed an original, all of which together shall constitute one and the same instrument. The Parties acknowledge that the consideration recited in this Agreement is the sole consideration for the undertakings herein, and that they are each executing this Agreement without any reliance upon any statement, representation, inducement, or promise, whether written or oral, by any person or party, other than those expressly contained in this Agreement. No conduct, failure, misunderstanding, or misinformation and no claim of fraud in the inducement occurring prior to or in connection with the execution of this Agreement shall be grounds for avoidance of its terms, rescission, or for recovery of damages

This contract/agreement is validated by the signatures below:

Signature*

Date*

Date