Client Information and Service Agreement Name * First Name Last Name Address * Street Address Address Line 2 City * Email * Home/Cell Phone * Dog's Name * Breed * Dog's Age * Dog's Sex * Male Male Neutered Female Female Spayed MEDICAL HISTORY: Vet Office/Vat's name * Current health problems/Medications: * Yes No Please Describe Type N/A if this does not apply Past medical conditions/Treatment: * Yes No Does your dog have any allergies, including food allergies? * yes No Is your dog easily handled by the vet staff? * Yes No Has he/she ever had to be muzzled? * Yes No May we contact and discuss health and behavioral issues with your veterinarian? * Yes No HISTORY: Where did you obtain your dog? * Breeder Individual Shelter Rescue Group Pet Store Friend/Relative Found stray Other If other, please specify below How long have you had your dog? * Do you have other pets? * Yes No Has your dog ever bitten another animal, dog, or person? If yes, please describe. * Has your dog ever shown any signs of aggression towards another animal, dog, or person? If yes, please describe. * DIET What type of food do you feed? (e.g., raw, dry kibble, canned) How often? How much? Does your dog finish all food at meals? Yes No Exercise What type of exercise and how long does the exercise last? TRAINING Previous Training Check all that your dog knows: Sit Down Stay Come Walk nicely on leash Leave it Give Wait Go to your place Quiet Off (furniture or when jumps up) Others (including tricks): Please describe your main behavior concerns and goals: * 1. The Pend Oreille Pet Lodge will endeavor to create as safe an environment as possible for the training of my dog and will offer only sound, safe, and responsible training and instructions. Pend Oreille Pet Lodge will not be responsible for any unintentional or negligent errors, omissions, or incorrect assertions. I have been told by Pend Oreille Pet Lodge and understand the inherent risks of owning a dog, including but not limited to the risk of dog bites to myself or others, and consequently I am and will remain responsible for the actions of my dog at all times, and I hereby agree to indemnify and hold harmless Pend Oreille Pet Lodge and trainer of any and all claims of injury, expense, costs, or damages caused by my dog. I understand that the recommendation of any other product or service is not a guarantee of my satisfaction with that product or service. 2 I authorize Pend Oreille Pet Lodge to take my dog into public spaces during his/her stay for the purpose of training my dog. 3. If you have left your pet with the kennel or trainer and the trainer determines that your pet is ill or injured and requires medical attention, the trainer will first call the phone numbers listed above regarding your pet’s symptoms, treatment option and estimates of cost. If no one can be reached however, please indicate below so the trainer and Pend Oreille Veterinary Service and Pet Lodge can make important decisions for your pet in your absence. * I authorize Pend Oreille Pet Lodge to administer or seek medical care for my dog(s) as determined appropriate by Pend Oreille Pet Lodge and I agree to indemnify and hold harmless Pend Oreille Pet Lodge for all and any results thereof. I will reimburse Pend Oreille Pet Lodge for any charges related to emergency care, including office visits, procedures, medications, surgeries, etc. I DO NOT authorize Pend Oreille Pet Lodge to administer or seek medical care for my dog(s) as determined appropriate by Pend Oreille Pet Lodge and I agree to indemnify and hold harmless Pend Oreille Pet Lodge) for all and any results thereof. 4. PAYMENT/ CANCELLATION POLICY: I understand that under no circumstance are deposits or monies paid toward training at The Pend Oreille Pet Lodge refundable or transferable. I also understand that I am responsible for payment in full regardless of whether I choose to complete the training program. The Pend Oreille Pet Lodge Canine Training Team reserves the right to terminate training services at any time due to non-compliance and/or lack of cooperation from the client. I will arrive to training sessions on time and understand that tardiness shall result in missed training time. PRIVATE LESSONS: We require a minimum of 48 hours advance notice for cancellation or reschedule of private lessons. Failure to give appropriate advance notice and “No- Shows” will result in session forfeiture. The first visit is considered session #1 of program and all package sessions must be completed within a five-month period from purchase date. THERE ARE NO REFUNDS offered for unused sessions in private lesson programs and monies are not transferable. GROUP CLASSES: Due to limited number of registration slots available: we offer a 100% refund for cancellations at least 7 days prior to the start date of the first class. WE DO NOT OFFER ANY REFUNDS for cancellations less than 7 days before the start date of the first class. There are no make-up lessons for class sessions that you miss. You can schedule a (50% discounted rate) private lesson for a missed session within 30 days of the missed class session. Unused sessions are not transferrable to future class dates and monies are not transferable. * I have read and accept the payment/ cancellation policy 5. VACCINE POLICY: I agree that the above- stated dog is current on (age appropriate) vaccinations that have been administered by a veterinarian. Including Bordetella (every 6 months), DHPP, and Rabies. I understand that I must provide appropriate documentation prior to the first visit. 6. Photo/ Video Release: I authorize Pend Oreille Pet Lodge to use my pet’s photograph(s) and/ or video(s) taken during training sessions for educational and promotional purposes in any type of media. * I have read and accept the vaccine and photo/ video release policy Date * MM DD YYYY Thank you! FOLLOW ALONG ON INSTAGRAM @PENDOREILLEPETLODGE
