Day Training Form

Full Name *

First Name Last Name

Pets Name *

Age/Breed/Sex

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

Alternate Phone Number

Area Code Phone Number

E-mail

Emergency Contact: *

Phone Number *

Area Code Phone Number

Veterinarian/Veterinary Clinic Name:

Clinic Phone Number

Area Code Phone Number

Current Medications/Reasons for Medications

Important Medical History Notes:

History of eating inappropriate items, History of seizures, etc.

Day Training Schedule agreed via email?

Yes No

Videos and/or Handouts will be shared with me on an as needed basis, roughly once weekly.

agree

Your training time begins at the scheduled appointment time. If you are late for your day training session, your dog misses out on valuable training time. The appointment will still end at the previously approved and scheduled time. *

I have read and agree to the above

Parking is available perpendicular behind my business vehicles. You are welcome to stay in your car or enjoy the lake by sitting in chairs around the fire pit or lakeside. I'm happy to share our peaceful front yard with you and offer an hour of rest while you wait. *

I have read and understand the above

Tardiness is not acceptable. You will be charged $1 for every minute you are late for your drop off or pick up. This includes day care participants. *

I have read and understand the above

3 behaviors of primary focus:

As discussed at the behavioral consultation

Liabilty Waiver and Policies

Neika Smessaert, RVT of Vet Tech Coach, LLC will endeavor to create as safe an environment as possible for the training and of my dog and will offer only sound, safe, and responsible training, and post-training instructions. However, I recognize that Neika Smessaert, RVT of Vet Tech Coach, LLC is not responsible for any unintentional errors, omissions, or incorrect assertions. I understand that the recommendation of any other 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 dog at all times and I hereby agree to indemnify and hold harmless Neika Smessaert, RVT of Vet Tech Coach of any and all claims of injury, expense, costs, or damages caused by the actions of my dog while under Neika Smessaert’s care and under my own care as a result of following training instructions. I have been told by Neika Smessaert, RVT of Vet Tech Coach, and understand the inherent risks in owning a dog, including but not limited to the risk of dog bites to myself or others.

I authorize Neika Smessaert, RVT to enter my home during agreed upon days and hours for the purpose of training my dog. (in-home training option)

I authorize Neika Smessaert, RVT to video record training sessions. These may be shared on various social media platforms including but not limited to Instagram and Facebook. Neika will never reveal identifying information about my home/family. These videos will also be shared with the family.

Payment Policy: Full payment due at the time of scheduling to reserve your space. No refunds are available.

Cancellation Policy: A cancellation 48 hours before the appointment will be rescheduled at no fee one time; any additional cancellation will be charged at the full fee. Any cancellation with less than 48 hours notice will be charged the full fee and not eligible for rescheduling. This includes if house entry is unavailable. Those sessions are not avaiable for rescheudling.

This contract is validated by the signature below in total and as approval for future services without additional written authorization.

Signature *

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Customer Details:

Emergency and Health Information

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