How did you hear of us?
Emergency contact- Include name and phone number.
List other family members including pets
Explanation for checking No re: Rabies Vaccination record.
Does your dog have physical limitations or medical problems? If yes, please describe.
Is your dog on medication now? If yes, please describe.
Do YOU have a physical limitation we should allow for? If yes, please describe.
Dog was acquired from
Age of dog when you acquired him/her
How long have you had your dog?
Have you had any previous dog training experience with any dog? When/Where?
What did you like the most about the training?
What do you want to accomplish with your training? List top 3.
List Cues (commands ) your dog can do reliably
Approximate % of time dog is inside and outside
Write %: For example, 50% outside, 50% inside.
% of time dog is without humans
% of time dog is tied
% of time dog is crated
About how many hours/minutes each day do you walk your dog on leash?
About how many hours/minutes each day do you play with your dog?
What do you like best about this dog?
What concerns you most about your relationship with THIS dog?
How often does your dog eat?
Does dog leave food for later?
Does your dog have a food allergy? If yes, please explain
Briefly explain trait(s) checked off
Anything else we should know about your dog?
What days/times are you available to schedule a 1-2 hour appointment?
Policies and Liability
Payment made by cash or check at registration or at beginning of session(arrangement made in advance). By checking the box below I have read, understand, agree to the above.
Cancellation and Refund Policy
Refunds and cancellations are offered until 72 hours prior to the scheduled session start date. To offer individualized attention no refunds will be offered if cancellation is less than 72 hrs, or a no-show. By checking the box below I fully I have read, understand and agree to the above.
Photography and Video Release Authorization Form
From time to time, photos and videos may be taken of students/event participants and their dogs during private and group dog training classes, practice sessions, demos, presentations and events organized by Sea Change Canine LLC. Sea Change Canine LLC reserves the right to use these photos and videos for educational and marketing purposes, its website, presentations, etc. By checking the box below, I hereby grant permission to Sea Change Canine LLC to use photos and videos of myself, my family and my guests as well as my dog(s) for the publications listed above.
I do not agree, but understand that a photo of my dog will be taken for internal records.
Sea Change Canine llc, Sarah Becker owner, will endeavor to create as safe an environment as possible for the training of my dog and will offer only sound, safe and responsible training and training instructions. However, I recognize that Sea Change Canine llc, Sarah Becker , owner, 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 Sea Change Canine llc, Sarah Becker, owner, of any and all claims of injury, expense, costs, or damages caused by the actions of my dog while under Sea Change Canine llc, Sarah Becker owner, instruction or control and under my own care as a result of following training instructions. I have been told by Sea Change Canine llc, Sarah Becker owner, and understand the inherent risks of owning a dog,including but not limited to the risk of dog bites to myself or others. By checking the box below I fully I have read, understand and agree to the above.
I understand use of equipment such as shock collars ;prong collars and choke chains can exacerbate aggression. I agree to follow safety measures discussed in my training program, such as the use of a muzzle. By checking the box below I agree to follow recommended safety measures.
I the owner/handler am ultimately and always responsible for the dog’s safety and the public’s safety, and that as an owner/handler assume 100% responsibility for the dog and the dogs' actions at all times. I as owner/handler agree to compensate Sea Change Canine LLC, Sarah Becker owner, any damages and costs of a claim, as well as attorney’s fees in the event of a third (3rd) party lawsuit. I as owner/handler warrant that I have disclosed to Sea Change Canine LLC, Sarah Becker, owner, that the dog may be fearful/reactive or aggressive to other dogs or to people, including but not limited to growling, forceful barking, snapping, raising of hackles, lowering head and staring, chasing, attempting to bite or biting.
I as owner /handler understand that while Sea Change Canine LLC, Sarah Becker, owner, may be able to address some forms of fear, reactivity, aggression, many fearful/reactive/aggressive dogs require long-term treatment following a specific plan of action. I owner/handler further understand that some forms of fear/reactivity/aggression cannot be addressed with behavior modification and may require medication or euthanasia, both of which are outside the scope of this contract. Sea Change Canine LLC, Sarah Becker owner, reserves the right to refuse or discontinue services for a fearful/reactive or aggressive dog, in which case Sea Change Canine LLC, Sarah Becker owner, will have no further obligation to owner/handler.
By checking the box below I fully I have read, understand and agree to the above.
Thanks for taking the time to complete this form. The information will help us determine the best course of
action for you and your dog.