Puptopia General Registration Form

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

E-mail*

How Did You Hear About Us?*

What service do you need? OR what class, date and time are you registering for?*

Pet Information

Dog's Name*

Gender*

MaleFemale

Breed*

Age*

Weight*

DOB*

Has Your Dog Been:*

SpayedNeuteredIn tact

Where did you acquire this pet?

Briefly describe your dog's personality. (quiet, confident, excitable, stubborn, bold, unruly, etc):*

Veterinary Information

Vet Clinic*

VACCINES ARE REQUIRED FOR CLASS AND YOU MUST HAVE VETERINARY PROOF. All dogs must be up to date on DHPP, Rabies, Bordetella and Leptospirosis vaccines before daycare, grooming, private lessons or classes. Vaccines differ depending on the age of the dog. Check with your vet.

Vaccination records*

Browse Files

Behavior and Training Information

Is your dog potty/housetrained? If not, briefly describe:*

Do you currently use a crate?*

YesNo

Does your dog like it?*

Yes, they go in on their ownSomewhat, they go in but it's not their favorite placeNo, he/she needs forced inNot really, but he/she can be enticed in with a rewardHates it and shows anxiety or aggression towards it

Describe any previous classes or training for your dog and where they took them:*

Level of success from that training?*

Does your dog know how to walk on a leash well?

YesNo

Does your dog sit?

YesNo

Does your dog lay down?

YesNo

Does your dog stay for 20 seconds?

YesNo

Does your dog come when called 100% of the time?

YesNo

Can you control their energy level?

YesNo

Describe unwanted behavior in greater detail:*

Please upload your dog's current photo*

AGREEMENT BETWEEN CLIENT (LISTED ABOVE) AND PUPTOPIA LLC

I understand that there are inherent risks associated with training, boarding, socializing, walking and working with dogs in general. I assume any and all responsibility for myself and my dog(s) during training, boarding, walking and any other work with Puptopia LLC, assuming due diligence and care have been exercised. I will not hold Puptopia LLC, Lisa Yan, any assistants, affiliates or property owners responsible for any injuries or misfortunes (to or by me or my dog) while training, boarding, walking or any other work, should they occur. I further understand that due to the way that dogs interact with one another, cuts or scratches can occur to me or my dog, even though the dogs are carefully supervised. I also understand that my participation in any of these activities is not without risks such as tripping, falling, getting knocked down and jumped on, bitten, scratched, etc.

I also understand that I am enrolling my dog(s) into Puptopia LLC's programs, packages or group classes when I do the following 3 things: 1) I accept this agreement by hitting "submit" below 2) I confirm and agree upon the training plan in writing which is usually via text or email 3) I put down a deposit or make a payment. I understand that Puptopia LLC relies upon my representation that my dog(s) are in good health and have received the necessary vaccinations (or equivalent alternatives) as agreed upon by my veterinarian. If my dog becomes injured or ill, Puptopia LLC and Lisa Yan shall have the right to reject me and my dog from class or refuse training. In the event of an emergency and my designated veterinarian is unavailable, Puptopia LLC has the right to take my dog(s) to the nearest animal hospital for immediate care, but it is not required of them. I agree to reimburse, in full, Puptopia LLC for any medical expenses accrued while under the supervision of Puptopia LLC. Puptopia LLC will not be held responsible for any decisions made by the veterinarian on the dog’s behalf.

I hereby release and agree to save and hold harmless, Puptopia LLC, Lisa Yan, any affiliates or property owners from any and all liability, claims, suits, actions, loss, injury or damage of any nature or kind, or for any liability, claims, suits, actions, loss, injury or damage which I or my dog(s) may sustain or which may be caused in any way by my dog(s). I specifically, without limitation, agree to fully indemnify Puptopia LLC, Lisa Yan any affiliates, assistants or property owners for any and all such liability, claims, suits, actions, losses, injury or damage. I understand that I am solely financially responsible for any damage or harm caused by my dog during training, boarding, socializing, or walking.

I take it upon myself to ask questions and use my own common sense. I understand that I do not have to do anything or allow anything to be done that I do not feel comfortable with. I have read Puptopia LLC's Policies on Puptopiadogs.com and will adhere to them.

I certify that I have read and understand the rules and regulations set forth herein and that I have read and understand this agreement. I agree to abide by the rules and regulations and accept all the terms, conditions and statements of this agreement and confirm the truthfulness of the contents of this release form completed by me. Some programs are not appropriate for all dogs. Puptopia LLC reserves the right to remove or refuse a dog from any of the Puptopia LLC programs.

By Clicking The Submit Button You Agree To The Above Terms

PUPTOPIA GENERAL REGISTRATION FORM