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Registration form for Monster Mutt Leash Reactivity Workshop - 297 Warren Street
Where did you hear of us?
Date & name of class you're signing up for
Breed or mix
Address/Phone if known
Reason for last vet visit
Does your dog have any allergies or medical problems?
Does your dog take any medication, including flea/tick/heartworm preventative?
How long have you had your dog?
Where did you get your dog?
Did your dog have other owners?
Please list other pets in the household
How many times a day does your dog go out?
How many times a day does your dog eat?
What exactly do you feed your dog?
How large is your living space? (studio, house, 2 bedroom, etc)
Who lives in the household?
Has anything in the household changed since acquiring your dog?
Describe how you leave from & return to your home (big hello & goodbye to the dog or no fuss)
What does your dog do as you prepare to leave?
What is your dog's training history, and at what age did you start?
Please list what your dog knows (sit, leave it, etc)
I grant my permission for Walk This Way Canine Behavior Therapy to work with my dog. If my dog is attending training or being treated for behavior problems, I understand that in the area of Obedience Training, owner compliance is necessary for the dog to understand and retain the training he/she has received. I also understand that in the area of Behavioral Problems, owner compliance and patience are key in the rehabilitation of my pet. I understand that any behavioral abnormality is controllable but not necessarily curable, especially when concerning aggression problems. I do not hold Walk This Way Canine Behavior Therapy or Monster Mutt Doggie Daycare responsible for the actions of my animal during or after treatment. I am aware that each dog participating in this class must have all necessary vaccinations (Rabies if age-appropriate, Distemper & Parvo), and wear proper ID. In addition, each owner must bring veterinary records of vaccinations to the first class or they will not be able to participate in the first session. If I do not vaccinate my dogs against these illnesses, despite the fact most veterinarians recommend that dogs are vaccinated regularly (boosters are usually done at approximately 15-16 months of age, and then again every 1-3 years), I take full responsibility for any consequence to my animal and/or myself and/or any other animal and/or person. By allowing my dog to be at Monster Mutt Doggie Daycare for training without being fully up to date on vaccines, I take full responsibility for any consequence to my animal and/or myself and/or any other animal and/or person. I hold Monster Mutt Doggie Daycare and Walk This Way Canine Behavior Therapy, together with their principals, agents and employees, harmless for any illness my pet may contract as a result of exposure to other animals, people or the facility at Monster Mutt Doggie Daycare. I agree that Monster Mutt Doggie Daycare and Walk This Way Canine Behavior Therapy shall not be responsible for injuries to others (or their pets) who may be injured by my dog or by my acts, and I shall indemnify Monster Mutt Doggie Daycare and Walk This Way Canine Behavior Therapy, their principals and their employees, for any and all costs, damages, claims or expenses (including reasonable attorneys' fees) that may result therefrom. I attest to the fact that to the best of my knowledge my dog is NOT in heat. If I am mistaken and an unwanted pregnancy results, I take full responsibility for any consequence to my animal. I hold Monster Mutt Doggie Daycare, Walk This Way Canine Behavior Therapy and the owner(s) of the impregnating dog, together with their principals, agents and employees, harmless and indemnify them for any resulting pregnancy and/or complications and/or illness resulting from such pregnancy while my animal is in Monster Mutt Doggie Daycare or Walk This Way Canine Behavior Therapy's care. I understand that any photos of my dog that are obtained during class might be used for publicity purposes or teaching purposes by Monster Mutt Doggie Daycare and Walk This Way Canine Behavior Therapy. I ALSO UNDERSTAND THAT ALL DEPOSITS AND CLASS FEES ARE NON-REFUNDABLE. I certify that I am the owner of this animal and I am authorized to make decisions about this animal’s health and safety. By entering my name in the box below, I certify that this is a legal and binding signature.
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