Jeff Stallings / Better Nature Dog Training

Jeff Stallings / Better Nature Dog Training Intake and Release Form Owner’s name: _____________________________________ Date: ________________________ Address: __________________________________City: ______________Zip: ________________ Email Address:__________________________________________________________________ Telephone Cell: _________________ Home: _________________ Work: ___________________ Dog’s Name: _____________________________________ Breed: _________________________ Dog’s Gender: M F Dog’s Age: ___________ Age when you acquired him/her? __________ Is your dog spayed or neutered? Yes No Where did you acquire your dog? (Breeder, pet shop, breed rescue, shelter, etc.) _______________________________________________________________________________ Is your dog possessive of food or toys? Yes No Has your dog ever bitten another dog? Yes No Has your dog ever bitten a human? Yes No If yes to any of the above please specify: ______________________________________ (Use back if necessary) What is your dog’s training history? Please check all that apply: No training__ Puppy Kindergarten__ Puppy Class__ Basic Obedience class __ Trained yourself __ If you’ve attended training classes, where? ______________________________________ How did you hear about my training services? ______________________________________ Veterinarian’s Name: __________________________ Phone: ____________________________ Veterinarian Release: I hereby give permission to Jeff Stallings / Better Nature Dog Training to contact my veterinarian clinic to verify my dog’s vaccination status or discuss issues that might be pertinent to behavior modification and/or training. Signature: _____________________________________________ Name (Printed): _________________________________________ Date: _________________________________________________ Jeff Stallings / Better Nature Dog Training Liability Release Owner’s name: ______________________________________ Dog’s name: ______________________________________ The owner agrees that Jeff Stallings / Better Nature Dog Training, any referring organization, other participants, representatives, or assistants will not be liable for any damages or loss resulting from counseling, instruction, or advice supplied to the dog’s owner. The dog’s behavior now and in the future is solely the responsibility of the owner of the dog. Should any behavior on the dog’s part now or in the future result in damages to property, owner, or persons of some third party, the owner agrees to assume the full responsibility and liability to such third party for any and all such damages and to absolve Jeff Stallings / Better Nature Dog Training, any referring organization, other participants, representatives, or assistants from any and all obligations to pay such damages to a third party. Owner agrees that any dog trained or otherwise handled by Jeff Stallings / Better Nature Dog Training, any referring organization, other participants, representatives, or assistants are not liable for loss or damage from disease, death, running away, theft, fire, injury to persons, other dogs, other animals or property by said dog. Owner agrees to follow all state, county, and city leash laws and all state, county, and city pet ordinances. Payment for behavior consulting and training is non-­‐refundable. Appointments canceled with less than 24 hours notice will be billed in full. I have read this liability release and agree to all terms and conditions herein. Signature: _____________________________________________ Name (Printed): _________________________________________ Date: _________________________________________________