Client & Dog InformationGuardians Name*Referred By:Home PhoneWork PhoneCell Phone*Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Dog's Name/ID*Dog's Name/ID*Breed/Age/Sex*Breed/Age/Sex*Emergency & Health InformationEmergency Contact*Phones*Vet Office/ Vet's Name":*Phone*Current MedicationsReason(s) for MedsImportant Medical History NotesMay we share your training & behavior report with your veterinarian?* Yes No Home InformationOther Professionals, Service Providers, or Visitors Expected During Training Hours:*Days Okay For Training Visits* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Times okay for training visits?*Between __ AM/PM and __ AM/PMDescription of Services*RateTotal DueAmount Due & Form of Payment*Paid in Full- Paid $*Date MM slash DD slash YYYY Liability Waiver & Policies1. Brea Cara will endeavor to create as safe an environment as possible for the training of my dog and will offer only sound, safe, and responsible training and training instructions. However, to the extent that Brea Cara is insured for any unintentional or negligent errors, omissions, or incorrect assertions, Brea Cara will be responsible for any such acts or omissions, but only to the extent of such insurance. I have been told by Brea Cara and understand the inherent risks of owning a dog, including but not limited to the risk of dog bites to myself or others, and consequently I am and will remain responsible for the actions of my dog at all times, and I hereby agree to indemnify and hold harmless Brea Cara of any and all claims of injury, expense, costs, or damages caused by my dog. I understand that the recommendation of any other product or service is not a guarantee of my satisfaction with that product or service.*Initial:2. I authorize Brea Cara to enter my home during agreed upon days and hours for the purpose of training my dog.*Initial:3. I authorize Brea Cara to take my dog off my property during the agreed upon days and hours for the purpose of training my dog.*Initial:4. I authorize emergency medical care to be provided for my dog(s) by the above-named veterinarian, or an appropriate alternate to be determined by Brea Cara in the event my regular veterinarian is not available or that closer care is required. I will reimburse Brea Cara for any charges related to emergency care, including office visits, procedures, medications, surgeries, etc.* I authorize Brea Cara to administer or seek 1st aid and resuscitative care for my dog(s) as determined appropriate by Brea Cara and I agree to indemnify and hold harmless Brea Cara for all and any results thereof. I DO NOT authorize Brea Cara to administer or seek 1st aid and resuscitative care for my dog(s) as determined appropriate by Brea Cara and I agree to indemnify and hold harmless Brea Cara for all and any results thereof. Initial:*Initial:5. Payment Policy:*Initial:6. Cancellation Policy:*Initial:This contract is validated by the signatures below in total and as approval for future services without additional written authorization.*Dog Guardian Signature:Date* MM slash DD slash YYYY Δ