New Client form

Ventura Pet Wellness & Dog Training Center

New Client Information Form

Today’s date ________________________

Your name ______________________________________________________________ 

Address_________________________________________________________________________________________________________________________________________

Phone number ___________________________________________________________

Cell number _____________________________________________________________

Email __________________________________________________________________

Dog’s Name_____________________________________________________________

Age of dog __________________  Breed _____________________________________

Where did you get your dog? _______________________________________________

How long have you had your dog?___________________________________________

Is this your first dog? _____________________________________________________

In regards to your relationship with your dog, what are your goals?

(For example, companion/ family dog, agility, social, therapy, etc)  Please list all that MAY apply.

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What you want your dog to learn? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What issues your dog has ________________________________________________________________________________________________________________________________________________________________________________________________________________________

What commands your dogs already knows

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Has your dog ever bitten a person or dog?  If so, explain

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Do you have other pets in your house? (please list)  Does your dog get along with them?

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Who lives with the dog (spouse, children….)

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I hereby acknowledge that I have voluntarily applied to participate in dog training activities with Shannon Coyner CPDT, RVT and Ventura Pet Wellness & Dog Training Center.

I am aware that there are inherent risks and hazards involved in activities with and around dogs, and I am voluntarily participating in these activities with knowledge of potential dangers. I am aware that any dog, regardless of training, handling, or environmental circumstance, is capable of biting and I expressly acknowledge the risks therein.

In order to participate in dog training classes or other activities, I, being fully informed of such risks and hazards, agree to assume all risks of such occurrences.

I hereby waive any and all claims or actions that I or my guardians or representatives may have, from any and all personal injury to myself, my dog, children in my charge, or harm to property or person caused directly or indirectly, through action or inaction of self or others, by acts that might occur in dog training classes, any other format of training activities or secondary training without trainer present or engaged.

I agree to indemnify Shannon Coyner and affiliates from any and all claims by myself, member of family, or any agent while within training facilities, within my home property, or in the general public as a result of any action or inaction, of either my dog or any another.

I also agree to assume sole responsibility for injury or damage caused by myself, children in my charge, or by the dog I own or handle and further agree to indemnify, defend and hold the instructors, trainers, assistants and property harmless from any damage, loss, liability or expense, including legal cost and attorney's fees, which result from damage caused by myself, children in my charge, or by the dog I own or handle.

I have provided current vaccination documents from a licensed veterinarian.

I have read the policies for dog training and I agree to adhere to them.

Client signature ________________________________________________  date___________________

Please bring a copy of your dog’s current vaccines (Rabies and DHPP required) to first class or training session.