Zippity Do Dog Adult Manners Training Form

Charm School 5-Weeks $425 (Five 1-hour sessions)

Finishing School 5-Weeks $425 (Five 1-hour sessions)

Full Name

First Name Last Name

Email

example@example.com

Phone Number

Area Code Phone Number

Do you receive texts

Yes No

What is the best way to reach you?

Phone call Email Text Facebook Messenger

Physical Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

How did you hear about me?

What is your dog's name?

Dog's age

Breed or mix

Dog's sex

Male Female

Is your dog spayed or neutered?

Yes No Not yet

Dog's weight

Coat type and color

Where did you get your dog? Please include NAME of rescue, shelter, or breeder if applicable.

Why did you obtain this dog? (Companionship, watchdog, sport competition, playmate for current dog, etc.)

How long have you had this dog?

If you got your dog as a puppy, how old was s/he when you brought him/her home?

Please list the top three behaviors that you want to teach your dog

Do you use a crate for this dog?

Yes No

Has your dog ever bitten anyone?

Yes No

Did the injury require medical treatment?

Describe the severity of the injuries inflicted:

Please explain the circumstances that occurred just before and around the time of the bite:

Is your dog motivated by food/treats?

Yes No

Is your dog motivated by toys?

Yes No

How do your exercise your dog?

What other enrichment opportunities does your dog get during the day?

Kongs Food Dispensing Toys Puzzle Toys Chew Toys None of the above

What equipment do you use to walk your dog?

Regular Flat Buckle Collar Martingale/Limited Slip Collar Choke Chain Prong/Pinch Collar Harness (regular or no pull style) Head Harness (Halti, Gentle Leader, Etc.) Muzzle

Do you (or a dog walker) walk your dog using a Flexi Leash or other Retractable Leash?

Has your dog ever worn an Electronic/Shock Collar?

No Yes, for training with me Yes, for training with a trainer Vibration only Invisible/Underground fence only I'm not sure

List any medications (including preventatives and herbal remedies) your dog is currently on:

Does your dog have allergies?

What brand of food do you feed your dog?

How many times per day is your dog fed?

Veterinarian (Name & Clinic/Hospital)

Has your dog had any previous training? List trainer name and location or self.

List any skills your dog already has (sit, down, stay,etc)

Are these skills 100% reliable under any circumstances?

Does your dog (check all that apply):

How long have you been dealing with the issues noted above?

How have you tried to fix these issues?

Have there been any significant changes recently in your dogs life? (a move, pet or person passed away or moved out, diet changes, etc.)

Please list any other pets in the home (name,breed,age)

Who lives in the home full time/part time? Include ages of children if applicable.

How much time does your dog spend home alone?

Where does your dog stay when home alone?

Where does your dog sleep at night?

How does your dog respond to people they do not know coming into the home?

Is there anything else, not covered in this intake form, that you would like me to know?

I am interested in (check all that apply):

Manners Training Assistance with introducing a new dog Transitioning a new shelter/rescue dog into the home

I understand that dog training and behavior modification is not without risk to myself, members of my family, guests, or my dog or other pets. I hereby waive my rights to any claim and release Lee Desmarais and Zippity Do Dog Training and Behavior Modification from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but not limited to, any injury or damage resulting from the action of any dog, and I expressly assume the risk of any such damage or injury while attending any training session, function or event wherever the activity is taking place. In consideration of and as inducement towards the acceptance of my enrollment in lessons, I hereby agree to indemnify and hold Lee Desmarais from any and all claims, or claims by me, any member of my family or any other person accompanying me to any training session wherever they may be located arising out of any action by any dog, including my own, including but not limited to the responsibility for all damages, expenses and legal fees. I further indemnify and agree to hold harmless Lee Desmarais from any and all claims, or claims by any third party at any training session wherever they may be located arising out of any action by any dog, including my own, including but not limited to the responsibility for damages, expenses and legal fees.

Programs are prepaid or due in full at the first consultation unless otherwise agreed upon by both parties. Any returned checks are subject to a $35 bank fee and a $20 late fee. Cash, personal checks, Venmo, Cash App are accepted, PayPal accepted for behavior consult deposits.

Cancellations received 72 hours prior to scheduled appointment will be accepted without penalty.
Cancellations due to inclement weather are not subject to penalty.
Cancellations received less than 72 hours prior to scheduled appointment will be subject to a $35 rescheduling fee.
Cancellations received less than 24 hours prior to scheduled appointment will result in the forfeiture of that session, with no refund.

I have read and, by completing this form and clicking submit below, agree to abide by the aforementioned Waiver and Assumption of Risk and Agreement to Hold Harmless.

Signature

Clear

Please verify that you are human *

Adult Training *

USD payment for training

Once you have submitted your payment you will be contacted to schedule your 5 sessions.

Zippity Do Dog Adult Manners Training Form

Additional Information