Short Intake Form Client InformationThe * means that it is a required field. Please provide as much information as possible.Client's First Name* Client's Last Name* Address Line 1* City*State*Zip Code*Email* Primary PhoneSecondary PhoneDog's NameDog's BreedDog's AgeIs Your Dog Spayed or Neutered?YesNoDog's GenderMaleFemaleWho is your regular veterinarian?In-home Training GoalsPlease click on all of the behaviors below that you would like to discuss during your private session.Impulse control: None Barking Chewing/Destruction Counter-surfing Digging Jumping Pulling on Leash Other Other (please describe)Puppy primer: None Building confidence Chewing Handling House training Mouthing Socialization Other Other (please describe)Dog 101: None Children and Dogs Distraction Strategies (Don't look at that) Exercise Focus Strategies (Look at me) Loose Leash Walking Mat work Mental Stimulation Play Stealing personal items/the chase game Other Other (please describe)Dealing with Change None Additional household members New baby New cat New dog New home New significant other Other Other (please describe)Are there any additional comments you would like to make?End of questionnaire.Terms and 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. Forty-eight hours notice is required for cancellation of enrollment in class. I understand that the instructor reserves the right to expel any person or dog (without refund) whose presence jeopardizes the safety of others. By checking this box I agree to the Terms and Conditions stated above* Agree Would you like to receive emails from our site in the future?*YesNoCaptchaCommentsThis field is for validation purposes and should be left unchanged.