Adult Dog Class Intake Form

YOUR OWN DETAILS:

First Name

Last Name

Phone

Address

YOUR EMERGENCY CONTACT DETAILS:

Contact First Name

Contact Last Name

Contact Phone Number

Contact Email

Dog's Name

Dog's Breed

Dog's Age

Has your dog had a physical exam done by a Veterinarian? Is you dog considered healthy and disease-free, parasite-free, and flea-free?

Is your dog current on their vaccines including: Rabies, Distemper/Parvo, and Bordetella?

How long have you had your dog?

Where did you adopt you dog from?

Does your dog have any known food allergies or sensitivities?

What are you hoping to achieve through this class?

Please tell us anything you'd like for us to know about your dog.

Has your dog had any vomiting, diarrhea, coughing, or sneezing in the last 21 days?

Do you agree to keep your dog home if they are sick?

Is your dog reactive? If so, what are their triggers?

Owner acknowledges and agrees that Dopamine K9 shall not be held liable for any loss, injury, or damage arising from any cause, including but not limited to acts of God, disease, death from natural causes, escape or running away, theft, fire, self inflicted injuries, injuries inflicted by other animals, or any incidents or injuries involving other participants. The owner accepts full responsibility for their dog and themselves in such situations and releases Dopamine K9 from any claims or liabilities related to these incidents.

Thank you for submitting! We are looking forward to working with you and your dog!

WELCOME TO THE PACK

YOUR OWN DETAILS:

YOUR EMERGENCY CONTACT DETAILS: