Canine Class Registration Form

Canine Class Registration Form

For In-Person & Virtual Session
Pawsitive Approach LLC @ Animal Assisted Therapy Services

4 Oxford Road, Building D, Suite 5/6, Milford, CT 06460

(203) 699-6DOG (364)

For questions about our dog training classes contact: Evelia at Pawsitiveapproach1@gmail.com
The mission of Animal Assisted Therapy Services is to provide persons with physical, cognitive, or psychosocial disabilities the opportunity to experience the power of the human/animal bond as therapeutic intervention thus promoting lifelong health and wellness.

The mission of Pawsitive Approach is to help create and keep a bond between you and your canine pal.

POLICIES AND GUIDELINES

Enrollment:

No one may participate in any AaTs activities until the following mandatory forms are filled out, signed, and dated by the appropriate party. By completing this online registration form, all of the following except for #3 are being completed. Please bring or fax a copy of your rabies certificate before the start of the first class.

1. Registration and Release Form

2. Photo/Video Release Form

3. Copy of rabies certificate.

AaTs/Pawsitive Approach staff is available for consultation throughout the application process and at any time during the program session. Please call with any questions, concerns, suggestions, or comments.

Attendance:

Regular attendance is expected from all participants. There are NO refunds for missed lessons.

Participants who must be absent should notify the office by phone or email 24 hours in advance.

In the event of unforeseen circumstances such as inclement weather or teacher illness, all reasonable attempts will be made to notify clients at least two hours prior to a schedule change. In the event that a lesson must be cancelled, the client will receive a make-up lesson.

Payment:

All payments are due prior to the first lesson of the session via paypal (available at the end of this registration form), check (payable to PAWsitive Approach, LLC), Zelle, Venmo or cash.
Registration & Release Form
Contact Information
Name

First Name Last Name
Date

Month Day Year
Date
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Email
example@example.com
Dog Information
Dog's Name
Dog's Breed
Dog's Age
Dog's Sex
Veternarian
Medical Issues / Medications / Allergies
How long ago was dog adopted?
Where did you obtain dog from?
Please select the following that apply:

House Broken Crate Trained
Any previous training? Behaviors dog knows/previous training used/previous trainers?
Class Information
Class Start Date

Month Day Year
Date
Name of Class
Class Time Slot

: Hour Minutes AM/PM Option
What are the top behaviors you want to work on with your dog?
Did anyone refer you to this class? How did you hear about us?
Liability Release

I, (name of individiual listed below), would like to participate in a Pawsitive Approach Program at Animal Assisted Therapy Services. I acknowledge the risks and potential for risks of working with animals, including the potential for bodily harm. However, I feel that the possible benefits are greater than the risk assumed. I hereby, intending to be legally bound for myself, my heirs and assigns, executors, and administrators, waive and release forever all claims for damages against Animal Assisted Therapy Services, its Board of Directors, Instructors, Aids, Volunteers, and/or Employees for any and all injuries and/or losses sustained while participating in the program from whatever cause including but not limited to the negligence of these released parties.

The undersigned acknowledges that he/she has read this Registration and Release Form in its entirety; that he/she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.
Name of Individual Accepting Liability
Signature *

Use your mouse to sign your signature. Clear

Authorization for Taking and Use of Photographs, Video, and Audio Recording
I AUTHORIZE ANIMAL ASSISTED THERAPY SERVICES (AaTs)/Pawsitive Approach, and any person acting on AaTs’s behalf, to take my photograph, or to create a video or audio recording of me, and to use that photograph or video or audio recording, or to use a photograph or video or audio recording previously taken by AaTs, for AaTs business purposes. I understand that AaTs’s business purposes include, but are not limited to, the creation of AaTs-sponsored publications, educational materials, and external marketing. I acknowledge that I am not a professional actor and am not generally known to the public. I understand that any photographs or video or audio recordings created by AaTs are AaTs’s property. I understand I will not be compensated for such photographs or video or audio recordings.

I hereby irrevocably authorize AaTs/Pawsitive Approach, LLC, or any person acting on its behalf, to edit, alter, copy, exhibit, publish or distribute any photograph or video or audio recoding of me for the purposes described above. In addition, I irrevocably consent to such use or disclosure without my prior inspection or approval of the finished product including written or electronic copy, wherein my likeness appears.

I understand that AaTs/Pawsitive Approach, LLC is not responsible for any use or disclosure of any photograph or video or audio recording of me not authorized by AaTs. I hold AaTs harmless from any loss, damage or injury resulting from any such unauthorized use or disclosure.
Name

First Name Last Name
Signature

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Parent/Guardian Signature

Use your mouse to sign your signature. Clear
Date

Month Day Year
Date

Should be Empty: