GROUP CLASS REGISTRATION Complete This Form and Email It As an Attachment to

GROUP CLASS REGISTRATION – Complete this form and email it as an attachment to .

(If you are not able to email it, you may send it via US Mail, along with a check for $128 made out to “At Your Service” to At Your Service Dog Training, PO Box 61, Wendell, MA 01379.)

Owner name:______

Mailing address:______City/State/Zip:______

Primary phone: ______Secondary phone: ______

Email: ______

Best way to reach me on short notice (e.g., snow cancellation, etc.)? ______

Name & start date of class I am registering for: ______

I prefer to pay (check one): __online by credit card invoice __ with acheck(by mail)

How did you hear of At Your Service? (If referred, please give their name) ______

If other family members will be attending class, please list their names and life stages. If under 18, please give age, as well:

Name:Child/Teen/Adult/Elder?

Does anyone in the family require any disability accommodations? If so, please describe how we may accommodate them:

Dog’s name: ______Breed/mix:______

Approx weight: ______Date of birth (or approximate):______

Date you acquired the dog: ______Sex: _____ Spayed/Neutered? ______

How did you acquire the dog(breeder/rescue/shelter)?

Health -- Bring current vaccination record to 1st class. We'll contact your vet for questions.

Veterinary clinic: ______Date of last visit: ______

Which vet does your dog see? ______Vet phone: ______

Is dog up-to-date on rabies vaccination? _____ Other vaccines your vet recommends? ______

Doesyour dog have any food allergies? Please list ______

Does your dog have any medical issues we should be aware of? (Describe)

Behavior

Is your dog very sensitive to certain sounds? If yes, what types of sounds?

Is your dog friendly toward new people?

Describe specifically what your dog does when your dog sees unfamiliar people:

Is your dog friendly toward new dogs?

Describe specifically what your dog does when your dog sees unfamiliar dogs:

Is your dog ever possessive of food, toys, or bones with people? Describe:

Ever possessive of food, toys, or bones with other dogs?Describe:

Has your dog bitten anyone, or has anyone claimed the dog has bitten them? Describe:

Training

Is your dog in training to be a service dog?

Please list any classes the dog has already taken or is currently taking:

Where/which trainer?

Do I have your permission to contact them?

Does your dog know any commands or behaviors already? If so, what?

Is there anything else we should know to make you and your dog welcome in class?

CONTRACT/DISCLAIMER: Read carefully. By initialing and signing, you indicate you agree with these terms.

LIABILITY: At Your Service Dog Training, LLC [hereafter “Trainer”] 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 Trainer is not responsible for any unintentional errors, omissions, or incorrect assertions. 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 Trainer of any and all claims of injury, expense, costs, or damages caused by the actions of my dog while under Trainer’s instruction or control and under my own care as a result of following training instructions. I acknowledge and understand the inherent risks of owning a dog and/or training a dog as a therapy or service animal including but not limited to the risk of dog bites to myself or others, needing to rehome or career-change a dog not suited to work as a service or therapy dog, and any attendant emotional or physical distress or injury resulting from raising/training a dog.

Initial: ___

Service and Therapy Dogs – No Warranty or Guarantee:

While Trainer endeavors to support Client in acquiring or training a dog/puppy that meets Client’s goals and preferences, Client recognizes that animal behavior is unpredictable and that animals may develop unforeseen health or temperament problems, or turn out to be unsuited to Client’s expectations or goals. Client agrees that At Your Service offers no guarantees, nor implied or expressed warranties that animals that Trainer recommends or assesses will meet Client’s training, behavior, pet or working goals.

Initial: _____

NON-REFUNDABLE/NO CANCELLATION POLICY: Trainer and I share the same goal: better behavior for my dog. Consistency and continuity are required for training and behavior modification. To support these goals, Trainer maintains a NO CANCELLATION/NO REFUNDS policy. If I miss a class, my lesson is forfeited. I understand that Trainer is under no obligation to allow my dog or myself to "catch us up" on material that we missed. I take responsibility for attempting to make it to all classes or for reading Trainer handouts to keep up with classes I miss. Unused services are forfeited and cannot be transferred to other people or used for other services.

Initial: ___

Products & Services -- NO GUARANTEE: I understand that the recommendation or provision of any product or service is not a guarantee of my satisfaction with that product or service.

Initial: ___

Media Permissions: My dog and/or I may be videotaped during lessons or consultations. Videos or recordings which capture or record my name, likeness, image, voice, or appearance may be posted to allow Trainer and I to share information to support the training of my dog. Pictures and videos of my dog taken by Trainer or shared by me with Trainer as well as my written communication about my dog to Trainer may be ALSO be used by Trainer on its website, promotion, publicity, or other materials, with the dog’s name and city. (This section is OPTIONAL. If you do not initial, you can still take the class; Trainer will avoid taking or sharing your picture.)

Initial: ___

GROUP CLASSES: I understand that group classes are not appropriate for all dogs. I have provided Trainer with accurate information to the best of my ability about my dog, my dog's habits, health, behavior, and training. However, I understand that, at the discretion of the instructor, any team may be removed from class. Whenever possible, Trainer will offer a private training session in the place of the balance of that course. Reasons a dog and handler team may be removed from class include but are not limited to: excessive barking, potentially unsafe around other dogs or people in the evaluation of the instructor, or not sufficiently in control by the handler during class. Trainer does not offer refunds.

Initial: ___

This contract is validated by my name and date below in total and as approval for future services without additional written authorization.

Name: Date:______