Rates & Services
Intake and Goal Assessment Form
Step 1 of 4
Thanks for caring enough about your canine family to invest in dog training! I'm a
CPDT-KA Certified Dog Trainer
. I use solution and science based training that is focused on FUN! !
Take a few moments to tell me about yourself and your best friend. This is a thorough questionnaire, it will help me understand your dog’s history and will help us maintain a safe and fun environment for everyone so we can focus on the training program during the sessions.
If this form does not seem to be working correctly
please call or email us directly
Address Line 2
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip/ Postal Code
Home or work address?
Date of Birth
Age of Dog
Is your dog spayed/neutered?
Is your dog fearful, reactive or aggressive around certain types of dogs or people?
Has your dog bitten another dog
Has your dog bitten or nipped a person.
If yes, describe the incident(s) in detail.
Date of Adoption or Intake:
Date Format: MM slash DD slash YYYY
I am interested in:
Walk & Train
Board & Train
Where did you obtain your dog?
How old was he/she when you got them?
Is he/she and inside or outside dog?
How did you hear about us?
Referred by a Rescue
Referred by CCPDT
Referred by IAABC
Who is your veterinarian?
What breed/breed mix is your dog?
Names of others in household who are involved with the care of your dog/s (include the age of any children)
Other pets in the household, type, breed, age, sex, and if spayed or neutered:
Has your dog ever been quarantined for any reason? If yes, please explain:
Describe your dog’s daily routine:
How much food, type of food and how often? Do you leave the food down all day or pick it up?
Does your dog have any dietary restrictions? If yes, please provide details.
What does your dog do for exercise, how often, and for how long?
What does your dog do when you’re gone from the house? And where do you leave your dog when you leave the house?
What kinds of toys, chews, etc. does your dog play with, and how often?
Is your dog on any medications? If so, please list them and describe what you are treating.
Does your dog struggle when you leave him/her alone? (If yes, describe the behavior below )
Describe the behaviors:
Have you done any prior training with your dog, or has he/she done any training before you adopted?
Where did they do the training?
Known Cues, please select below
Go To Spot
Can you describe the basic approach you learned to train your dog?
Do you feel you got the results you were looking for? Why or why not?
What are your dog’s favorite foods, treats and toys?
What are your dog’s favorite activities?
How does your dog respond to other dogs approaching when you’re out on a walk?
Does your dog exhibit any of the following behavior problems? Please choose the relevant behaviors and choose approximate frequency:
Excessive barking or howling
Mouthiness - teeth on skin (hands etc.) or clothing
House Training (urination, defecation, marking, submissive or excitement urination)
Chases (cars, people, other dogs)
Object & food stealing or possessive
Jumping up (guest - owner - fences)
Overly submissive behavior
Fearfulness (shy or phobic reaction) add triggers such as noises, men with hats, kids, big dogs etc.
Running away or Escape Artist digging under, jumping over, destroying objects
Lunging or Pulling on leash
Coprophgia (eats poop)
Destructive Chewing, Scratching, Biting, etc.
Sensitive to Touch
Other Problems ( describe )
What goals would you like to see your dog/s achieve during training? For any behaviors you would like to see diminish or extinguish, describe what you would like to see your dog do instead.
Is there anything else that you would like to mention about your dog that I did not cover?
I agree that all information above is accurate.
TERMS & CONDITIONS
I agree to the outlined TERMS & CONDITIONS
The Puppy Care Company will endeavor to create as safe an environment as possible for the care of my animals. However, I recognize that neither Christine Young (Trainer) nor The Puppy Care Company contractors are responsible for any unintentional errors, omissions, or incorrect assertions. I understand that the recommendation of any product or service is not a guarantee of my satisfaction with that product or service. Further, I am and will remain responsible for the actions of my pet(s) at all times and I hereby agree to indemnify and hold harmless Christine Young & The Puppy Care Company contractors of any and all claims of injury, expense, costs, or damages caused by the actions of my pet(s) while under The Puppy Care Company’s care and under my own care as a result of following training instructions. I understand the inherent risks of owning pet(s), including but not limited to the risk of dog bites to others or myself.
I understand the behavior of a moment-to-moment decision-making animal can never be guaranteed. Therefore, my animals behavior correlates to the amount of time I spend practicing desired behaviors and the degree of consistency family members and I employ.
DOG TRAINING SESSIONS:
During your ﬁrst training session, we can provide a bit of extra time to go over the paperwork, any special instructions, help you complete the forms, and acquire keys and/or codes if you choose the day training option, you must ﬁll out the
Let us know your preference for us to gain access to your home. If there is a code include the speciﬁc code instructions on the Intake form. If you are supplying a key and make a copy key be sure that you have checked to make sure it works. Access: We understand that you may have others who have access to your home such as relatives, neighbors, cleaning or repair services while you’re away or at work. The Puppy Care Company is not responsible for any damages incurred to your home or pet by said persons or businesses. Please let us know via text if there will be anyone else with access to your home during our visits. (We are also happy to bring in packages, pick up mail on the walks, etc )
TERMS & CONDITIONS
Payment (check, cash, or e-transfer – Venmo, Apple Pay, etc.) must be made during registration process or upon arrival at ﬁrst session/class. NSF cheques or payments are subject to a $45 dollar fee. After payment for services is made refunds are not offered. As a small business I hope you can understand my limitations once payment has been made. Your Intake Goal & Assessment Form must be ﬁlled out including a full history of your dog as well as your contact information.
A minimum of
notice is required to cancel a scheduled session without penalty. Client acknowledges that without such notice, Trainer is unable to schedule another client to make up for the cancellation.
The client may reschedule or cancel ONE prescheduled training session without penalty.
Any subsequent reschedules or cancellations will count as and be charged as a prepaid session in the training plan. It is imperative that sessions be scheduled on a consistent basis and in a timely manner. More than two rescheduled or canceled appointments will void all contracted services with Christine Young & The Puppy Care Company.
Additionally, failure to complete a training program within six months from date of the initial consultation may be construed as a termination of services and will relieve Christine Young and The Puppy Care Company from any further obligation to the client, deeming all paid fees non-refundable. Trainer will work with Client to reschedule a class or session cancelled with 24 hour’s notice by rescheduling to a future date so long as it is rescheduled within 6 months of the initial class or session.
Trainer endeavors to create an environment that is as safe as possible for the Client, Trainer and the Dog. However, Client understands that any activities involving any animal involve a risk of possible injury to people or the animal.
Client agrees to indemnify, defend and hold harmless Trainer for any and all liabilities, loss, injuries or damages of any type resulting from the Dog. Client further agrees to waive, release and hold harmless Trainer for any injury or illness suffered by Dog that is not the result of an intentional act or the gross negligence of Trainer. Client agrees that Trainer’s liability shall in no event exceed the lesser of the amount of the current chattel value of the Dog or the amount actually paid by Client for Trainer’s services over the past 6 months from the date that any liability arose.
If Client engages other dog training services apart from Trainer, Client acknowledges that Trainer is not associated with nor responsible for any other dog training services.
Trainer guarantees that Trainer will work with the Dog and Client as a team to try to achieve the best behaviors and education for the Dog. However, Trainer makes
warranty, guarantee or representation regarding the progress or success of any of Trainer’s services or advice. Client understands and agrees that genetics, environment and a Dog’s prior history may affect Dog’s behavior and that Trainer’s services may not cure or resolve any particular problem or achieve a particular result. Client recognizes that a Dog may at any time resume an unwanted behavior. Trainer has not represented, promised, guaranteed or warranted that: the Dog will never exhibit other behavioral problems, or that the results of the training will last for any particular amount of time. Client also recognizes that continual practice and repetition of training techniques with positive reinforcement is necessary in order to promote desired behaviors and lessen unwanted behaviors.
HEALTH & TEMPERAMENT:
Trainer requires that the Dog is in good health and up-to-date with all necessary vaccinations. Dogs that are sick or recovering from illness are not permitted to partake in training sessions or class. Trainer may cancel any training class or sessions without refund in the event that Trainer reasonably believes that the Dog is currently afflicted with a contagious disease, including but not limited to, rabies, distemper, kennel cough, and parvovirus, or has fleas or ticks, or that the training might harm the Dog. Trainer advises Client to only hold training if the Dog is in good health and up-to-date with all necessary vaccinations. Client acknowledges that Trainer is exposed to numerous animals every day and as a result may have been exposed to diseases or vermin (e.g. fleas) that may be harmful to the Dog. If, in the sole and absolute discretion of the Trainer, the Trainer believes that the training may be harmful to the Dog, to Trainer, to other animals or to other people, the Trainer may elect to terminate training or require animals or people to leave the area before proceeding with training. In the event that Trainer terminates training, Trainer shall refund Client for all future classes or sessions that Client has pre-paid for. Fees for classes or sessions that have been held, including up to the date of termination, are non-refundable, and any fees paid for such classes or sessions are deemed earned by Trainer. Trainer reserves the right to remove a Dog from a training program.
If your dog is not neutered or spayed please disclose this as we may have to ensure they are safe during class or sessions. If your dog is in heat they may not attend classes or sessions. You may attend class without your dog in these cases and this is encouraged.
Be sure that your dog has ID tags.
If your dog has a bite history you must disclose this at time of registration. Those with a bite history must be safe during classes and if muzzle trained wear a muzzle. If they are not yet muzzle trained please contact me so we can ensure they are introduced to this equipment in the correct way.
We reserve the right, in the name of safety for everyone, to decide that group classes are not a ﬁt for your dog if their behavior is not acceptable or productive for the environment. If this is the case, we will make arrangements for private training and apply a credit towards such from the initial payment made for the class.
RESCHEDULE/ACTS OF GOD
Any training class or session cancelled for the convenience of the Trainer or due to inclement weather or events outside of Trainer’s control (i.e. “acts-of-God”) shall be rescheduled at a mutually convenient date or a refund issued to Client at Trainer’s discretion.
Client hereby gives his or her full consent to all photographs, audio recordings, academic work, and/or video recordings taken of me, my pet(s), and family members (including minor children) during any services provided by Trainer. Client agrees to seek similar consent from any persons present during Trainer’s services held at Client’s property. Client understands that any such photographs, audio recordings, academic work, and/or video recordings (“Media”) become the property of Trainer and that Trainer may use such Media without restriction and without any compensation owing to Client. Trainer may use such Media for educational, instructional, or promotional purposes in any format now existing or in the future created.
Time is of the essence in this Agreement.
The Client may not delegate, assign or transfer its obligations to pay any fees owed under this Agreement without the prior written consent of the VM3. Except as provided by the immediately preceding sentence, this Agreement shall be binding upon and inure to the benefit of the parties and their respective heirs, legal representatives, successors and assigns.
Wherever possible, each provision hereof shall be interpreted in such manner as to be effective and valid under applicable law, but in case any one or more of the provisions contained herein shall, for any reason, be held to be invalid, illegal or unenforceable in any respect, such provision shall be ineffective to the extent, but only to the extent, of such invalidity, illegality or unenforceability without invalidating the remainder of such invalid, illegal or unenforceable provision or provisions or any other provisions hereof, unless such a construction would be unreasonable.
This Agreement contains the full and complete understanding and agreement between the parties with respect to or relating to the subject matter of this Agreement, and supersedes all other agreements between the parties, whether written or oral relating thereto, and may not be modified or amended except by written instrument executed by both of the parties hereto. Any ambiguities in this Agreement shall not be construed against the drafter. No failure or delay by a party to insist upon strict performance of any term, condition, obligation or covenant of this Agreement, or to exercise any right, power or remedy hereunder or under law, or as a result of a breach of this Agreement or a violation of law, shall constitute a waiver of any such term, condition, covenant, agreement, right, power or remedy, or preclude such party from exercising any such right, power or remedy at any later time or times.
HEADER ARE FOR CONVENIENCE ONLY.
The headings of paragraphs, sections and other subdivisions of this Agreement are for convenient reference only. They shall not be used in any way to govern, limit, modify, construe this Agreement or any part or provision thereof or otherwise be given any legal effect.
EXECUTION IN COUNTERPARTS.
This Agreement may be executed in any number of counterparts, and each such counterpart shall be deemed to be an original instrument, but all such counterparts together shall constitute a single agreement. Delivery of an executed counterpart by facsimile or by email shall be equally valid.
CLIENT PROPERTY & AUTHORIZATION TO ENTER PROPERTY.
If services are to be provided at Client’s home or other location owned, rented or otherwise controlled by Client (“Location”), Client is advised to secure all valuables prior to Trainer’s arrival at the Location. Trainer shall not be liable for loss or damage of Client’s valuables or other personal property due to the acts or omissions of third parties. The Client and/or the person signing this Agreement authorizes Trainer to enter the Location, and affirms that he or she has the authority to grant Trainer permission to enter the Location for the purposes stated in this Agreement. Client and/or the person signing this Agreement shall indemnify Trainer from any and all claims of trespass or improper entry by anyone claiming an ownership or occupancy rights in the Location, e.g. landlord, owner, tenants, guests, roommates, etc.
OTHER TERMS AND CONDITIONS.
Any additional terms attached to this Agreement are incorporated into this Agreement by this reference.
The client has the right to refuse any part of the functional assessment, training class and/or behavior change program including any training exercises they feel are inappropriate. It is recommended that client openly communicates with the trainer/behavior consultant, and the behavior change or training program may be adjusted to reﬂect the client’s wishes. The client has the right to ask further questions and be clear on all relevant details before consenting to the consulting relationship.
This contract is validated by signing below and as approval for future services without additional written authorization.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date first set forth above. BY SIGNING BELOW, CLIENT ACKNOWLEDGES THAT HE OR SHE HAS READ THE ENTIRETY OF THIS AGREEMENT, AND AGREES TO ALL OF THE TERMS OF THIS AGREEMENT.
This signature states that you have read and understand the Liability Waiver and Policies outlined on this page.
Date Format: MM slash DD slash YYYY
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