Train Walk Poop Client Contract Training and Daycare Program 801-686-8364 www.trainwalkpoop.com Please complete this form and return it to Train Walk Poop or e-mail it to info@trainwalkpoop.com If you are registering more than one dog please complete a separate form for each dog. All dogs must remain on Leash at all times, no Flexi leads allowed. Please attach your dog s proof of current vaccinations to this form. Owner Name: Telephone Numbers: Home: Cell: Work: email address: Mailing address: Dog s Name: Age: Sex: Male Female Is your dog neutered or spayed? Yes No Training Registration Form Page 1 of 6
What is the breed (or breeds if mixed) of your dog: How many children live in the home with the dog? What are the ages of the children? Does your dog sleep in your bedroom? Yes No In your bed? Yes No Do you feed your dog at specific times or do you free feed? How much do you feed? What type of food? What other pets live in your home? (Please tell us the species/ name/ age and sex of other pets.) Does your dog interact well with other pets? (If no, give an explanation of any relationship problems between your dog and other pets.) Do you live in a (Check one) Multi-level House Ranch House Apartment Loft Townhouse Other Do you have a yard? Yes No Is your yard fenced? Yes No Do you have an invisible fence? Yes No Does your dog jump fences? Yes No Training Registration Form Page 2 of 6
Does your dog tolerate being crated? Yes No ***Part of training includes teaching your dog to enjoy his or her own space for quiet time in their crate. Is there anything you would like us to know about your dog s present reaction to being crated?*** Has your dog ever chewed or eaten his bedding while in a crate? Yes No Please place an X in the box next to any of the problems you re having with your dog. Is not housebroken. Is overactive and doesn t settle down easily. Mounts people or objects. Urinates when excited/ afraid. Jumps on people. Is aggressive towards dogs. Growls at family members or new people. (If yes explain when and why.) Is a nuisance barker or whiner. Play bites. Chews destructively. (If yes explain on what, when and why.) Does not come when called. Bolts through open doors. Training Registration Form Page 3 of 6
Guards toys, food, objects, etc. Guards space. Is shy. (If yes explain towards what.) Stresses easily. Pulls on leash. Has bitten. (If yes explain who, why, when, and the severity of the bite. Was blood drawn? How many times has your dog bitten?) Sniffs at or eats from counter tops. Jumps on furniture he/she shouldn t. Has separation anxiety. Digs in the yard. Other Other problems you would like to resolve with your dog: What is your veterinarian s name and phone number? Is there anything else we should know about your dog? Training Registration Form Page 4 of 6
Is your dog on any medications? Yes No If yes, please explain type of medication and schedule. What are the most important things we can teach your dog to help you enjoy your pet to the maximum? How did you find Train Walk Poop? Additional Information or Comments: Train Walk Poop Release Form I,, release all instructors, assistants, participants, spectators, and all land owners from any damages that may arise, directly or indirectly, as a result of me or my dog participating in activities offered by Train Walk Poop, Corp, fully recognizing that dog training, dog socializing & sporting activities of this nature can be HAZARDOUS. I understand and I am aware that all dog training & related sporting activities involve a risk of injury to any and all parts of the users body, or my dogs body. Despite the risks of injury, I AGREE TO EXPRESSLY ASSUME ALL RISKS of injury or death to me, or my dog while participating in any of the training and or socializing related activities. By my signature below, I give my consent to participate in said activities, and I realize that by signing & submitting this form as a legal release, I am forever releasing from liability and agree not to sue Train Walk Poop, Corp, Ryan Gwilliam, his associates, agents & employees for injuries or damages to me or my dog from any and all manner of actions, causes of such actions, claims and demands whatsoever, in law or in equity, which may arise now or in the future because of, or pertaining to, my participation, or my dog(s) participation in any activities through out any program provided by Train Walk Poop, Corp. I understand this is legally binding on me and my heirs and I sign it of my own free will. Signature Date: The undersigned person has registered to participate in training and/or socializing at Train Walk Poop, Corp. 1. I hereby certify that I am the owner of (dogs name), the dog(s) which will participate in training and/or socializing. 2. I understand that other dogs will attend Train Walk Poop s programs and that during the course of participation my dog may come into direct contact with all other participating dogs. Training Registration Form Page 5 of 6
3. I hereby certify that the above named dog has been fully vaccinated for canine distemper, canine parvo virus, canine hepatitis, and canine parainfluenza (DHPP), as well as bordetella (kennel cough), and rabies. The requirements to participate in any program are DHPP within the last year, Bordetella within the last 6 months, and rabies in accordance with local laws. I am aware that my dog may be exposed to those infectious diseases described above. However, since Train Walk Poop, Corp has advised me that my dog should be fully vaccinated against those diseases before attending any program; I alone assume responsibility for any such exposure. I also acknowledge that in addition to the diseases described above my dog may be exposed to other infectious diseases. However, in order for my dog to participate in training and/or socializing, I alone assume the responsibility of such exposure to all other infectious canine diseases. 4. I am aware that given the sometimes-unpredictable nature of dogs, an interaction could take place between animals at Train Walk Poop, Corp which may result in injury to my dog. I alone assume responsibility for any such injury to my own dog. 5. As to Train Walk Poop, Corp and its employees, I hereby waive and release any actions, causes of actions, damages, rights, claims or lawsuits which I may have for: (a) any and all personal injury or property damage which may be sustained arising out of any interaction between dogs participating in any programs; and (b) any and all injury, illness or disease sustained by my dog arising out of or stemming from its participation in any programs offered by Train Walk Poop, Corp. 6. I have read and understand this release form and I will honor and abide by the terms and conditions set forth above. I understand and agree that genetics and environmental history (e.g. past experiences, lack of training, nutrition, health, etc.) can affect my dog s behavior. I understand and agree that this training may not be able to cure my dog s aggression, or other problems, and I further understand and assume all risks associated with owning and harboring a dog that may be aggressive. As a condition of my dog s participation in training with Train Walk Poop I agree to waive all claims against Ryan Gwilliam, Train Walk Poop owner and to indemnify and hold Ryan Gwilliam and Train Walk Poop, it officers, agents, and employees, harmless from any and all liability or claims I may have or that any other person or entity may have because of any death, bodily injury, personal injury, or because of any loss to property that may arise out of or in any way be connected with my dog s training. I agree that Train Walk Poop does not guarantee that my dog will do or stop doing any specific behavior after training; I understand that Train Walk Poop agrees to offer follow up support and training, whether by telephone or in person, as long as I shall own my dog. I agree that if, by agreement between Train Walk Poop and myself, my dog needs additional training for a period of more than one day, I shall permit my dog to stay overnight at Train Walk Poop, that I will not be charged additional training fees, but that I will pay a boarding fee not to exceed $30.00 per night. I agree that follow up training appointments, if needed, will be conducted at a location specified by the owner and/or staff of Train Walk Poop. I agree that in the event of a medical emergency or if asked for medical procedures, Train Walk Poop may have my dog treated by a veterinarian of their choice, and I will be responsible for the cost of any medical treatment. Disputes over the quality of dog training services provided shall be resolved by the use of binding arbitration with an arbitration firm whose panel of arbitrators consists of impartial lawyers, non-lawyers, and retired judges. Train Walk Poop and I shall bear our own fees and costs of the arbitration. Prior to entering this agreement, I have read this agreement and understand that I have the right to have an arbitration agreement reviewed by counsel in order to advise me if it is in my best interest. I agree that the non-refundable fee for service is $1950.00 for the 2 Week Boot Camp $995.00 for the 1 Week Boot Camp, or $650.00 for the Mini Boot Camp Program. Should Train Walk Poop determine in their sole discretion, that my dog is not suitable to complete the program for any reason, I will be responsible only for the $100 per over night, no equipment shall be included, but I will not be responsible for the remainder of the fee. Printed Name of Dog Owner: Date Signature of Dog Owner Training Registration Form Page 6 of 6