Our Application Forms PDF Version for Intake Client Information and Agreement Form PDF Version for Authorization to Release Veterinary Records Client Information Client Information & Dog Training Agreement Client Information First Name * Last Name * Phone Number * Email Address Address * City * States * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code * Dog's Name * Breed/Mix * Age * Gender * Male Female Weight * Where did you obtain your dog? * Breeder Friend/Relative Found Stray Pet Store Shelter Rescue Group Other How long have you had your dog? * Have you owned other dogs in the past? * Yes No Lifestyle Does your dog play with other dogs? * Yes No Are there other pets in the home? * Yes No List Species What type of exercise does your dog gets? * (Frequency and type (dog park, walks, fetch, etc.)) Do you provide regular enrichment activities to your dog? * (Puzzle toys, brain games, Kongs, etc.) What are your dog's three favorite things? * Environment Please list all people, including yourself, who interact with your dog on a regular basis: * Name, Gender, Age (if Children), and Relationship to you. Where is your dog kept when you are not home? * Indoors not confined Indoors confined In yard not confined In yard confined Other On an average day, how long is your dog without human companionship? * Training Has your dog had any formal training before? * Yes No If so, what was your experience? What equipment do you use on your dog? * Collar Clicker Harness Gentle Leader Leash Rewards Other If other, which equipment do you use on your dog? Training Goals What are your training goals? * Is there anything else you think would be important for Upward Dog Colorado to know? Dog Training Agreement THIS AGREEMENT (“Agreement”) is by and between Upward Dog Colorado and the Owner of the Dog, (hereinafter referred at as “Client”) and entered into for the sole purpose of hiring Upward Dog Colorado to provide training for both Client and Dog. Please check each gray box after reading each section: SERVICES: Trainer agrees to provide private lessons for Client and Dog on a lesson-by-lesson basis, the goal being to teach Client how to train and work with Dog. Trainer will make every reasonable effort to help Client achieve training and behavior modification goals but makes no guarantee of Dog’s performance or behavior as a result of providing professional animal behavior training. Checkboxes TERMINATION: Upward Dog Colorado and/or it’s trainers shall terminate services if (a) if any Trainer and/or Upward Dog Colorado judges Dog dangerous or vicious to Trainer or any other person or animal (b) Client breaches any term or condition of this Agreement, or (c) Client requests service termination. Client understands and agrees that Upward Dog Colorado’s duties shall terminate but all other provisions of this Agreement shall remain in full force and effect. ie. Prepaid packages are non-refundable but transferable. Checkboxes CANCELLATION POLICY: If Client fails to give at least 24-hour cancellation notice or is not present at the time of scheduled appointment, session fees are still due. For the training packages, the session will be counted as one session. Checkboxes DISCLOSURE: By signing this Agreement, Client represents to Upward Dog Colorado that Dog has not been exposed to any contagious diseases within a thirty-day period prior to the all training sessions. During the period of this Agreement, Client agrees to notify Upward Dog Colorado of any known exposure of Dog to a communicable disease and will resume training sessions with a written veterinary clearance. In addition to, Client represents and warrants to Upward Dog Colorado that (a) Dog is free of all fleas, ticks, worms and other insects and parasites (b) all information given about Dog is accurate and truthful. Checkboxes RELEASE: Client agrees to allow Upward Dog Colorado to use Dog’s name and any images or likeness of the dog, including photos or videos of the dog taken while it is receiving services from Upward Dog Colorado, in any form or format, for use, at any time, to be posted on Upward Dog Colorado’s social media outlets, or to be used in any media including marketing/advertising materials, illustrations, trade or promotional materials. Checkboxes LIMITATION AND LIABILITY: Client agrees, understands and acknowledges that the elimination or modification of behaviors is not guaranteed. Client acknowledges that dog training will not provide exact results and that failure to follow the professional advice given to them by Upward Dog Colorado may result in as escalation of behavior and training issues. Client further agrees to accept responsibility for any damages the above name Dog may cause through malicious, aggressive or improper behavior that may occur before, during or after all services provided by Upward Dog Colorado, on or off Client’s property or Business or any other location, that Client accepts the risk and agrees that Upward Dog Colorado shall not be held liable for it or any resulting injuries, losses, damages, costs or expenses. Checkboxes ARBITRATION: Any dispute or claim arising out of or relating to this Agreement, or the breach thereof, or as the result of any claim or controversy involving the alleged negligence by any party to this Agreement, shall be settled by arbitration administered in Denver, Colorado in accordance with the Commercial Arbitration Rules of the American Arbitration Association. The arbitrator’s decision shall be final and binding and judgment upon the award rendered by an arbitrator may be entered in any court having jurisdiction thereof. The arbitrator shall, as part of the award, determine an award to the prevailing party of the costs of such arbitration and reasonable attorney’s fees of the prevailing party. The arbitrator shall not be authorized to assess special, punitive, indirect or consequential damages against either party. Checkboxes ENTIRE AGREEMENT: This Agreement contains the entire agreement between the parties. Upward Dog Colorado makes no representations or warranties except for those expressly stated in the Agreement. All terms and conditions of this Agreement shall be binding on the heirs, administrators, personal representatives and assigns of Client and Upward Dog Colorado. This Agreement is governed by the laws of the State of Colorado, without regard to its conflicts of law principles. If any provision of this Agreement is determined to be unenforceable, such provision will be deemed severed and the remaining provisions of this Agreement will continue in full force and effect. BY SUBMITTING THIS, CLIENT ACKNOWLEDGES AND AGREES TO ALL TERMS, CONDITIONS AND LEGAL PROVISIONS SET FORTH IN THIS ENTIRE AGREEMENT WITH UPWARD DOG COLORADO. FURTHERMORE, CLIENT ACKNOWLEDGES THAT BY INITIALING AND SIGNING THIS AGREEMENT, CLIENT ACCEPTS AND AGREES TO BE LEGALLY BOUND BY ITS TERMS. reCAPTCHA Submit Authorization to Release Veterinary Records Vet Records Client Information First Name * Last Name * Phone Number * Email Address Address * City * State * Zip Code * Dog's Name * Breed/Mix * Age * Gender * Male Female Authorization to Release Veterinary Records Vet Hospital * Veterinarian * Phone * Fax Email Please include copies of * Vaccination Records Pathology Reports Laboratory Reports Radiology Reports Exam Reports Surgery Reports Entire Medical Record * From ____ to ____ At your earliest convenience, please return the requested documents to: Upward Dog Colorado Email: info@upwarddogcolorado.com I hereby certify that I am the Owner (Pet Parent) or authorized agent of the Pet Parent of the above-described pet(s). Further, I hereby request and authorize this veterinarian to release the requested medical information for my pet(s) to Upward Dog Colorado. I release the veterinary hospital, the veterinarian and all staff from any legal responsibility or liability for the release of information to the extent indicated as authorized herein. This authorization expires 90 days from the date of this form submission. I understand I may revoke this authorization, but the revocation may not be applied retroactively once the information specified herein has been released. reCAPTCHA Submit