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Initial Contact Form

Personal Information

How did you hear about us?

Pet's Information

Dog's Date of Birth
Single choice
Male
Neutered Male
Female
Spayed Female
Date and Place of Adoption
Rabies vaccination up to date?
Yes
No
Distemper/parvo vaccination up to date?
Yes
No

Primary Behavior Issues

Human Aggression/Fear
Animal Aggression/Fear
General Behavior
Basic Skills and Manners and New Dog

Please read and sign the release:

*Waiver, Assumption of Risk and Agreement to Hold Harmless*

I understand that attendance at a dog obedience class is not without risk to myself, member of my family, or guests who may attend, or my dog, because some of the dogs to which I(we) will be exposed may be difficult to control and may be the cause of injury even when handling with the greatest of care. In consideration of, and as an inducement to, the acceptance of my registration for classes, private training, or any other activity provided by Wholistic Hound Academy, I agree to indemnify and hold harmless, and hereby waive and release Wholistic Hound, LLC, it's employees, owners, and agents from any and all liability of any nature, for injury or damage resulting from the action of any dog including my own, and I expressly assume the risk of any such damage or injury while attending any training session or other function of this training facility or while on the training grounds or the surrounding area. I hereby consent to my dog being the subject of the photographs and/or audiovisual recording and authorize Wholistic Hound, LLC, its agents, and owner Sandy Modell to cause the same to be exhibited for educational purposes as still photographs, transparencies, motion pictures, television, video or other similar media.

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