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Behavioral Questionnaire & Private Contract

Please review this entire questionnaire & contract first, then go back and answer the questions as thoroughly as possible.
If there was an incident (such as a bite), if possible, please ask those who were present for input as well.

Behavioral Questionnaire
 
     

What is the main issue you are concerned about? (check all that apply)

 
 
 
 
     
     

Please check off any of the following that coincided with the change in your dog's behavior.

   
   
   
   
   
     
     
     

If your dog has threatened or bitten another dog, please check all that apply.

 
 
 
 
 
     

If steps have been taken to address the issue, did your dog's behavior improve, worsen, or stay the same?

 
 
   
     

If your dog has threatened or bitten a person, please check all that apply.

 
 
 
 
 
 
 
   
     

For each specific incident, please provide the following information.
(Use the [+] at the end of the incident questions, if you need to provide information about more than one incident. You may fill out the questions for up to three incidents, use the checkbox at the end to indicate if there are more then three incidents.)

No


If there was a bite:

Did it cause bruising? No

Was there bleeding (torn skin)?

Was there a puncture wound?

Were there multiple puncture wounds?

Did the dog bite, latch on and shake his head from side to side, not letting go?



[+] (add another incident)

     
More then 3 incidents:
(you may fill out up to three incidents, if you have more please check the box above.)
     

Which of the following best describes your feelings about your dog's behavior issue?

If there was a bite, was medical help sought?

 
If there was a bite, was it reported?  


If there was a bite, was legal action taken?  


     
     

Private Contract
This Agreement between of (hereinafter referred to as "Client") and Mike Deathe acting as agent for K.I.S.S. Dog Training (hereinafter known as "Trainer") pertains to the following:
     
Dog's Name:  
(hereinafter referred to as "Dog")    
     

For good and valuable consideration, the parties agree as follows:

Training Fees:

  1. Client agrees to pay Trainer a nonrefundable fee in the amount of $80.00 for 1 session (approximate
    length 1 hour)
    . OR

  2. Client agrees to pay Trainer a nonrefundable fee in the amount of $160.00 for first 2 sessions (approximate length 1hr each and $80.00 for each follow-up session (approximate length 1 hour). OR

  3. Client agrees to pay Trainer a nonrefundable fee in the amount of $400.00 for a package of 6 sessions (approximate length 1 hour each) to be paid at first session. All sessions must be completed within 2 months or 8 weeks from the date of commencement of contract or they will be forfeited.

  4. Please notate any discounts in this area- ½ price adoption dog, ½ price additional dog- coupons and percentage off

  5. Weekend rates are 20.00 per hour more. Please indicate if you want weekend sessions or weekday sessions (available from 9-4 M-F except Thursdays from 9-12)
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. These lessons will take place at Client's home. 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 consultation. Client understands that he/she and members of the household must follow Trainer's instructions without modification, work with dog daily as recommended, and constantly reinforce training being given to Dog. 

Cancellation Policy: If Client fails to give at least 24 hours cancellation notice, or is not present at time of scheduled appointment, session fees are still due. For a package deal, the session will still be counted as one session.  

Liability:  If Dog causes property damage, or bites or injures any dog, animal or person (including but not limited to Trainer and Trainer's agents), during or after the term of this Agreement, then Client agrees to pay all resulting losses and damages suffered or incurred, and to defend and indemnify Trainer and Trainer's agents from any resulting claims, demands, lawsuits, losses, costs or expenses, including attorney fees. If Dog is injured in a fight or in any other manner during or after the term of the Agreement, Client assumes the risk and agrees that Trainer should not be held responsible for any resulting injuries, losses, damages, costs or expenses.

At Trainer's sole election, Trainer's duties hereunder shall terminate if (a) in Trainer's sole judgment Dog is dangerous or vicious to Trainer or any other person or animal, or interferes with the training of other dogs, or (b) Client breaches any term or condition of this Agreement. Upon termination in accordance with the foregoing, Trainer's duties shall terminate but all other provisions of this Agreement shall continue in full force and effect.  
 
This Agreement is binding upon Client, spouse of Client, and children of Client. This Agreement supersedes all prior discussions, representations, warranties and agreements of the parties, and expresses the entire agreement between Client and Trainer regarding the matters described above. The parties confirm that, except for that which is specifically written in this Agreement, no promises, representations or oral understandings have been made with regard to Dog or anything else. Without limiting the generality of the foregoing, Client acknowledges that Trainer has not represented, promised, guaranteed or warranted that Dog will never bite, that Dog will not be dangerous or vicious in the future, that Dog will not exhibit other behavioral problems, or that the results of the training will last for any particular amount of time. This Agreement may be amended only by a written instrument signed by both Client and Trainer.

 
By checking this box I, hereby acknowledge that I'm digitally signing the Private Lesson Dog Training contract above.

Email:


Phone:

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