Group Module Intake Application - Hoboken Pawsitive Experience

Thank you for your purchase

We are Pawsitively excited you are here!

Please complete this online Intake Form and accept our Terms and Policies prior to attending any Modules.

Section 1: Your Information

Name *

First

Last

Email *

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Section 2: Dog's Information

Dog's Name

Male/Female?

Male
Female

Dog's Breed

Dog's Age

Dog's Weight

Dog's Date of Birth or Gotcha Date

Spayed/Neutered?

Please describe your training objectives.

Section 3: Medical History

All Allergies and Food Restrictions

Please provide up to date Vaccination Records *

Click or drag files to this area to upload. You can upload up to 10 files.

Section 4: Terms and Policies

Dog’s requirements:

Your dog will have a safe and strong 5-6 foot leash.
Must stay current on vaccinations
Must wear their name tag and other registration tags
Must have a collar or harness

Cancellation Policy

A minimum of 48 hours notice for cancellations of any appointment are required. Cancellations made less than 48 hours prior to you appointment may be charged the full rate.

Photographs

Photos and videos of my pet taken during the training sessions and can be used in Hoboken Pawsitive Experience materials and social media.

Terms

You authorize this contract is valid for the earlier of your last Module session in your package or 4 months from date of purchase. Scheduling your Modules is completed online.
You understand that Hoboken Pawsitive Experience is required to report any dog bites that may occur. You will be responsible for costs/payments due to bites.

Release of Liability

I do hereby waive and release Hoboken Pawsitive Experience from any and all liabilities of any nature for the actions of myself, my pet(s), or any other person who accompanies me; except those arising from negligence or willful misconduct on the part of Hoboken Pawsitive Experience. This includes third party incidents. You agree to notify Hoboken Pawsitive Experience in writing to hobokenpawsitiveexperience@gmail.com of any concerns within 24 hours

I understand that Hoboken Pawsitive Experience can terminate this contract if my pet becomes a threat to the safety or health of Hoboken Pawsitive Experience or the community due to aggressive behavior. Hoboken Pawsitive Experience reserves the right to refuse service to any client, at any time, for any reason. I acknowledge I am responsible for medical expenses and damages resulting from an injury to Hoboken Pawsitive Experience employees or other person or animal caused by my pet(s).

I attest that all the above information is true to the best of my knowledge. If anything changes from what is listed, I will inform Hoboken Pawsitive Experience before the next service is scheduled.

Signature