Information Form Information Form What are you interested in? Type of Session * Private Session(s) Puppy Kindergarten Premier Puppy Combo Package Basic Manners Best of Basic Combo Package Beyond Basic Therapy Dog Great Outdoors Tricks Fungility Scentwork To enroll for the class you listed above or schedule a private session, you MUST call 845-634-4344. Client Information First Name(s) * Last Name(s) * Primary Phone # * Secondary Phone # Email Address * Please list the names and ages of other people living in your household. Dog's Name * Breed or Breed Mix (If known or best guess) * Age (If known or best guess) * Veterinarian * All Creatures Great & Small Animal Medical of NC County Animal Hospital Dr. Colleran Dr. Lindell Dr. Murphy Haverstraw Animal Hospital Hudson Valley Animal Hospital Nanuet Animal Hospital North Rockland Animal Hospital Palisades Animal Hospital Pomona Animal Hospital Rockland Holistic Valley Cottage Animal Hospital Vet at the Barn Wagging Tails Animal Hospital Other Veterinarian Your Home Address * City * State * New York New Jersy Connecticut Zip Code Additional Information Gender * Male Female Spayed/Neutered Yes No Referred By: * Canine Coaching Website Other Internet Source Vet Referral Former Student Friends Dapper Dog HiTor North Star Other Shelter/Rescue Yellow Pages American Kennel Club Association of Pet Dog Trainers Certification Council for Professional Dog Traniers Other Professional Organization Any behavioral concerns? Does your dog ever growl, snap or bite (if so, please describe in detail)? * Any health problems? Terms and Conditions Agreement to Terms & Conditions I, the Client, agree to fully cooperate in completing the training sessions as taught by Hudson Valley Dog Training, LLC dba Canine Coaching staff. I will practice the homework assignments to develop the proficiency in the tasks being taught. I understand that every dog reacts in a different manner to training and that dogs are, by nature, unpredictable. Therefore, dog training requires full attention and total awareness at all times. Animals may, without warning, cause injury to humans and/or other animals. I understand and agree that Hudson Valley Dog Training, LLC dba Canine Coaching is not responsible for the behavior of the pet at any time, now or in the future. I, the undersigned, as RELEASOR, in consideration of Hudson Valley Dog Training, LLC dba Canine Coaching, as RELEASEE, release RELEASEE’s heirs, executors, administrators, successors, employees, agents, directors, officers as to attacks, bites, mauling, or all of them, by dogs or other animals to any person or animal including my own for the safety of myself, my dog, those around me and those dogs around me while learning dog training and while working with my dog. I sign below in recognition of my understanding that any injuries received by me, others and/or by my dog or other animals while taking classes, participating in behavior consultations, or after such activities in my home or at any other location are my own responsibility. I further affirm that I will always inform my instructor and Hudson Valley Dog Training, LLC dba Canine Coaching, in writing, of any unusual difficulties or conditions my dog may be experiencing prior to the beginning of a training session or behavior consultation, or during such sessions. This release may not be changed orally. For Behavior Consultations, Hudson Valley Dog Training, LLC dba Canine Coaching agrees to obtain a history of the pet, information about the pet’s living environment and family members, to assess the situation and develop a behavior modification plan, “The Plan”, to attempt to modify the behavior of the animal to the client’s satisfaction. Client agrees to divulge all relevant information to Hudson Valley Dog Training, LLC dba Canine Coaching and to follow the instructions developed by Hudson Valley Dog Training, LLC dba Canine Coaching in the Plan completely and in a timely manner. Client further understands that if the pet lives or comes in contact with other family members, that these individuals may be required to participate in The Plan if it is to produce favorable results. Client also understands and agrees that Hudson Valley Dog Training, LLC dba Canine Coaching is not responsible for the behavior of the pet at any time, now or in the future. No refunds will be made due to client inability to complete full lesson package. All sessions must be completed within 3 months from the first session. Twenty-four hours notice is required for cancellation of enrollment in class or a scheduled private session. I understand that the instructor reserves the right to expel any person or dog (without refund) whose presence jeopardizes the safety of others. Agreement to Terms & Conditions * I have read the terms & conditions and agree to them. Submit If you are human, leave this field blank.