Section 1: Owner Details

Surname*

First Name*

Street Address*

City*

Telephone Number*

Your Email*

Postal Code*

Please list members of the household:

Section 2: Dog Details

Dog's Name*

Please detail any other pets in the household including name, species, breed, age, sex and time in household.

Section 3: Owner Experience

How long have you been a dog owner?*

Have you had experience with this breed before?*
---YesNo

Explain

Have you attended any of the following with your dog?*
Puppy ClassDog TrainingAgilityPrivate Trainer Boarding Kennel(s)Dog SitterNone of the AboveOther

If "other" please specify

Section 4: Medical History

Has your dog attended a veterinary practice for any medical condition other than routine vaccination/check ups?*
---YesNo

Please give any details

Has your dog ever been hospitalized for any reason?*
YesNo

Please give any details

Is your dog currently on any medication?*
YesNo

Please give details

Is there any other medical information you feel may be significant?

Name of your dog's veterinarian.

Name of veterinarian practice.

Section 5: Daily Routine

What is your dog normally fed?*

Who feeds the dog?*

When does the dog get fed?*

Who walks the dog?*

Is the dog walked on or off a lead?*
OnOffBothWe don't walk

Please describe a normal day in the life of your dog, indicating the difference between weekdays/weekends. Important details like meal times, walks, time alone, etc should be included.

When does your dog prefer to sleep?

When does your dog actively seek affection?

Is your dog sensitive to your touch or petting?
YesNo

If the answer to the above questions is yes, list the body parts that are sensitive.

Will your dog choose to spend time alone, even when you are at home?

Please name your dog's 5 favorite toys, in order of preference.*

Please name your dog's 5 favorite treats, in order of preference.*

Which of the following commands does your dog respond to RELIABLY? Reliably is defined as 8 out of 10 repetitions are correct.*

SitStayLie DownComeLeaveNone of the Above

Please complete the following information describing your dog's normal behavior and how frequently it occurs*

Please describe your dog's response to each of the following:*

Section 6: The Problem Behavior

Please give a brief description of the problem:*

When did it start?

Please describe the first/last and most serious episodes

First

Last

Most Serious

Please complete the following questions describing your dog's bite history and how frequently it occurs:*

If a bite did occur, did the person or animal require medical attention?
YesNo

What has prompted you to look for behavioral advice now?*

Have you sought advice from any other source about this problem?*
FriendsFamilyVetDog TrainerBehavioristNone of the Above

How have you tried to manage the problem up until now?

What has been the result?

Please give any other relevant information relating to this problem in as much detail as you can:

Section 7: Prognosis

Please indicate which statement best describes the situation between you and your dog now:
---The problem is not severe but we would like to correct it if we can.The problem is moderate and we would like to correct it if we can.The problem is severe but we will keep our dog whether it can be corrected or not.The problem is severe and we will consider rehoming our dog if it cannot be corrected.

Thank you for taking the time to complete this questionnaire. It will be an immense help in ensuring you get the most benefit from your behavior consultation

RELEASE AND WAIVER OF CLAIMS

The undersigned who is a spectator or participant in dog training activities, in consideration of use of facilities covenants and agrees as follows:

GENERAL RELEASE. The undersigned hereby releases and waives any claims that the undersigned may now or hereafter have against the dog training facility, dog training activity sponsor(s), Tracy Calsavara, her instructors or their assigns from and against any and all liabilities, losses, damages, costs or expenses of whatever kind or nature, including attorney's fees, which the undersigned may incur as a result of any injury to the undersigned or their dog(s), or personal property of the undersigned as a result of the undersigned's activities undertaken at said facility including, without limitation, personal injury and damages thereof including loss of income, earnings, bodily injury, pain and suffering, emotional or mental distress and any and all medical expenses.

ASSUMPTION OF RISK. The undersigned acknowledges and understands that the dog training activities undertaken involve potential risk of personal injury and injury to personal property including dogs which may result from the undersigned's participation in dog training activities. Such injuries may be caused by other participants, the undersigned, facility conditions including, but not limited to, uneven or damaged terrain, the presence of moisture or mud, obstacles and obstructions upon or under the terrain and other natural or man-made conditions which may be hazardous to the undersigned or create hazards to the undersigned's activities. The undersigned further acknowledges that these dog training activities are potentially dangerous and assumes all risk of injury and/or damage which may result from any reason whatsoever thereby.

BINDING EFFECT. The foregoing provisions shall be fully binding upon and shall be effective against the undersigned, its heirs, successors, legal representatives or assigns and shall apply to the actions of the undersigned personally, the undersigned's family, guests, employees or agents.

IN WITNESS WHERE OF, the Agreement is executed this: Date

I hereby agree to abide by the rules of Absolutely Fetching Dog Training, that no dog shall be physically or verbally reprimanded while engaged in any activity sponsored by or affiliated with Absolutely Fetching Dog Training, or while on the premises of Absolutely Fetching Dog Training (with the exception of dogs committing acts of aggression towards people or other dogs). I further understand that any violation of this agreement could lead to the immediate termination of my involvement in the event or activity (including being asked to leave the premises) without refund of any monies paid for that event or activity.

I the undersigned hereby consent to the use of any and all photos taken by Absolutely Fetching to be used in, social media posts, advertisements, promotional material, or for any other purposes Absolutely Fetching so chooses.

I further agree that any photos taken by Absolutely Fetching are the intellectual property of Absolutely Fetching so that Absolutely Fetching and their licensees and assigns may duplicate, distribute, exhibit, or otherwise use the material or any portion of them without restriction, in perpetuity.

I have read and agree to abide by the above statement: Full Name

I 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.

Initials

Where did you hear about Absolutely Fetching?
---Friend/FamilyVeterinarianHumane SocietyInternet SearchSocial MediaLocal EventAdvertisingWoofaroofOther