Name

Email Address

How did you hear about us?

Phone

Alternate phone

Address1

Address2

City

State

Zip

Emergency contact

Dog's Name

Dog's Age

Dog's Weight

Dog's Primary Breed

Is your dog neutered/spayed? Is your dog neutered/spayed? Yes No

If not neutered/spayed, are you planning to do so? If not neutered/spayed, are you planning to do so? Yes No

Name of Vet

Vet Address

When and how did you acquire your dog?

Describe all your dog's medical issues and/or allergies

Why did you choose your dog?

What problems are you experiencing with your dog? Please be as specific as possible!

Describe all of your dog's prior training. What training tools (harness, gentle leader, martingale) did the trainer use? Were they effective?

What methods have you tried to stop your dog from performing any undesired behaviors?

Commands your dog knows (check all that apply) Commands your dog knows (check all that apply) Sit Down Knows Name Come Place No Good Yes Crated House Trained Knows No Commands

Has your dog ever been in a fight? Has your dog ever been in a fight? Yes No

If yes, please explain

Is your dog leash reactive (barks, growls, lunges)? Is your dog leash reactive (barks, growls, lunges)? Yes No

If yes, please explain

Is dog aggressive toward other dogs, animals or humans? Is dog aggressive toward other dogs, animals or humans? Yes No

If yes, please explain

Is your dog reactive when guests arrive at your home? Is your dog reactive when guests arrive at your home? Yes No

If yes, please explain

Does your dog jump on or mouth people? Does your dog jump on or mouth people? Yes No

If yes, please explain

Does your dog exhibit any fearful behavior? Does your dog exhibit any fearful behavior? Yes No

If yes, please explain

How does your dog behave in the car?

Has your dog ever broken out of a crate or jumped a fence? Has your dog ever broken out of a crate or jumped a fence? Yes No

How does your dog behave at the vet?

Does your dog let you groom him/her or touch his/her nails? Does your dog let you groom him/her or touch his/her nails? Yes No

Is your dog ever around children? Is your dog ever around children? Yes No

If yes, please describe

What do you feed your dog? What brand and how much per day? Is your dog free-fed or does your dog eat all of the food at mealtimes?

Is your dog crate-trained? Is your dog crate-trained? Yes No

If not, please explain why

Where does your dog sleep?

Is your dog food or toy aggressive? Is your dog food or toy aggressive? Yes No

If yes, please explain

Do you have a fenced-in yard? Do you have a fenced-in yard? Yes, have fenced yard No, do not have fenced yard

Are other animals in the home? Are other animals in the home? Yes No

If yes, please list all. Has your dog shown any aggression to any of them?

Has your dog ever killed or injured any animal? Has your dog ever killed or injured any animal? Yes No

If yes, please explain

Has your dog ever bit a human? Has your dog ever bit a human? Yes No

If your dog ever bit a human, please explain.

Do you walk your dog? Do you walk your dog? Yes, we walk our dog No, we do not walk our dog

Additional Comments

What type of physical/mental exercise do you conduct with your dog?

Which of our services interest you? Which of our services interest you? 30-Minute Consultation (Fee applied toward training when you sign-up) Board and Train Private Lessons Open Group Classes

What do you expect to gain from this training?

1. Peace & Unity Pet Services will endeavor to create as safe an environment as possible for the training and boarding care of your dog(s) identified above (the “Dog”), and will offer only sound, safe, and responsible training, care, and post-¬boarding training instructions. Owner agrees, however, that all animals may exhibit unpredictable behaviors and that Peace & Unity Pet Services will not be liable for the actions of your dog that are outside of the control of Peace & Unity Pet Services. Owner agrees that the recommendation by Peace & Unity Pet Services of any product or service is not a guarantee of performance or Owner’s satisfaction with that product or service. CHECK BELOW 1. Peace & Unity Pet Services will endeavor to create as safe an environment as possible for the training and boarding care of your dog(s) identified above (the “Dog”), and will offer only sound, safe, and responsible training, care, and post-¬boarding training instructions. Owner agrees, however, that all animals may exhibit unpredictable behaviors and that Peace & Unity Pet Services will not be liable for the actions of your dog that are outside of the control of Peace & Unity Pet Services. Owner agrees that the recommendation by Peace & Unity Pet Services of any product or service is not a guarantee of performance or Owner’s satisfaction with that product or service. CHECK BELOW I agree.

2. Peace & Unity Pet Services agrees to indemnify and hold Owner harmless from and against any claims of injury, expense, costs, loss or damages caused by the gross negligence or willful misconduct of Peace & Unity Pet Services while Owner's dog is in the sole custody, care and control of Peace & Unity Pet Services. Owner acknowledges that Peace & Unity Pet Services have no control over Owner's dog when Owner's dog is not in the exclusive custody, care and control of Peace & Unity Pet Services. Owner agrees to indemnify and hold Peace & Unity Pet Services harmless from and against any and all claims of injury, expense, costs, loss or damages caused by the actions of Owner's dog when Owner's dog is not in the sole custody, care and control of Peace & Unity Pet Services. CHECK BELOW 2. Peace & Unity Pet Services agrees to indemnify and hold Owner harmless from and against any claims of injury, expense, costs, loss or damages caused by the gross negligence or willful misconduct of Peace & Unity Pet Services while Owner's dog is in the sole custody, care and control of Peace & Unity Pet Services. Owner acknowledges that Peace & Unity Pet Services have no control over Owner's dog when Owner's dog is not in the exclusive custody, care and control of Peace & Unity Pet Services. Owner agrees to indemnify and hold Peace & Unity Pet Services harmless from and against any and all claims of injury, expense, costs, loss or damages caused by the actions of Owner's dog when Owner's dog is not in the sole custody, care and control of Peace & Unity Pet Services. CHECK BELOW I agree.

3. Owner acknowledges and agrees that owning any animal, including Owner's dog, has inherent risks, including but not limited to the risk of dog bites to Owner, other people, and animals. CHECK BELOW 3. Owner acknowledges and agrees that owning any animal, including Owner's dog, has inherent risks, including but not limited to the risk of dog bites to Owner, other people, and animals. CHECK BELOW I agree.

4. I understand if I do not follow PUPS recommendations and training regiment for my dog, that my dog may revert back to his old behaviors and continue to not behave properly. You will NOT hold Peace & Unity Pet Services responsible. CHECK BELOW 4. I understand if I do not follow PUPS recommendations and training regiment for my dog, that my dog may revert back to his old behaviors and continue to not behave properly. You will NOT hold Peace & Unity Pet Services responsible. CHECK BELOW I agree.

5. I understand any deposits submitted to Peace & Unity Pet Services are non-refundable once my reservation has been confirmed, and confirmed reservations are non-transferable. CHECK BELOW 5. I understand any deposits submitted to Peace & Unity Pet Services are non-refundable once my reservation has been confirmed, and confirmed reservations are non-transferable. CHECK BELOW I agree.

6. I hereby assign and grant to Peace & Unity Pet Services the right and permission to use, reproduce, distribute, and publish the photograph(s), film(s), videotape(s), audio and video recording(s), electronic representation(s) and/or sound recording(s) made of me and/or my dog(s) at any time during the training and/or boarding of my dog(s) by Peace & Unity Pet Services, and I hereby release Peace & Unity Pet Services from any and all liability resulting from such use, reproduction, distribution, and publication. I hereby authorize the reproduction, sale, distribution, copyright, exhibit, broadcast, and/or electronic storage of any and all such photograph(s), film(s), videotape(s), audio and video recording(s), electronic representation(s) and/or sound recording(s) without limitation at the discretion of Peace & Unity Pet Services and I specifically waive any right to any compensation I may have for any of the foregoing. Please check below to verify that you have read these terms and Agree to this Video & Photo Release Agreement. 6. I hereby assign and grant to Peace & Unity Pet Services the right and permission to use, reproduce, distribute, and publish the photograph(s), film(s), videotape(s), audio and video recording(s), electronic representation(s) and/or sound recording(s) made of me and/or my dog(s) at any time during the training and/or boarding of my dog(s) by Peace & Unity Pet Services, and I hereby release Peace & Unity Pet Services from any and all liability resulting from such use, reproduction, distribution, and publication. I hereby authorize the reproduction, sale, distribution, copyright, exhibit, broadcast, and/or electronic storage of any and all such photograph(s), film(s), videotape(s), audio and video recording(s), electronic representation(s) and/or sound recording(s) without limitation at the discretion of Peace & Unity Pet Services and I specifically waive any right to any compensation I may have for any of the foregoing. Please check below to verify that you have read these terms and Agree to this Video & Photo Release Agreement. This check serves as my virtual initials, agreeing to all the terms above.