Private Registration Form • Escape The Crate

Your Private Training Pet Profile

Dogs are required to be vaccinated against Rabies as per CT State Law. Vaccinations against distemper, parvovirus, hepatitis, parainfluenza and Bordetella are also recommended. Proof of Rabies vaccination is required prior to the first class.

We cannot work with any dog without up-to-date Rabies Vaccination. Please communicate with your instructor if the information on your pet’s profile has changed.

Completing this profile will create a Pet Profile ID required for checkout when purchasing a private lesson.

Private Training Pet Profile

Dog Owner's Name*
Dog's Name*
First
Owner's Email*
What specific issues are you having with your dog?*
What has led you to consider private lessons?
What is the best day / time for training?*
When is the best time to call you to make arrangements?*
Owner's Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Mobile Phone #*
Male / Female*
- Male
- Female
Dog's Age*
Dog Breed*
Dog's Weight
Is the dog Spayed/ Neutered?*
- Yes
- No
Is the dog housebroken?*
- Yes
- No
Is your dog on monthly flea and tick prevention?*
- Yes
- No
Good with other dogs?*
- Yes
- No
- Unsure
Does your dog show any signs of fear, reactivity or aggression towards people, children or other dogs?*
- Yes
- No
- Unsure
If you answered Yes or Unsure, please give any details you can here:
Good with other children?*
- Yes
- No
- Unsure
Any special needs? (Please provide detail)
Microchipped? If YES, please provide chip#
Veterinarian Info
Is the dog up to date on vaccines?*
- Yes
- No
Dog's Rabies Tag #*
Rabies Expiration Date*
Veterinarian's Name (or Clinic)*
Vet or Clinic Address
Street Address Address Line 2 City State ZIP Code
I understand that participation in the Dog obedience classes offered by Escape the Crate, LLC is not without some risk to myself, members of my family, guests who may attend, or my dog; that despite dogs appearing healthy and being handled with the greatest amount of care and foresight, dogs are not always predictable and the unexpected may occur. I hereby waive and release the Escape the Crate, LLC, their employees, volunteers, owners, and agents from any and all claims while on the grounds or surrounding areas thereto, and resulting from participation in training with Escape the Crate, LLC including specifically, but without limitations, any injury or damage resulting from the action of any dog. I understand and agree that the results of training may vary due to many factors including, but not limited to, the breed or mix of the dog, prior experiences, and the amount of time spent practicing the training. I further understand that participants and guests in classes are expected to abide by the rules and policies set forth by Escape the Crate, LLC. The undersigned acknowledges that he/she has read this Registration and Release Form in its entirety; that he/she understands the terms of this release and has signed this release voluntarily and with full knowledge of the effects thereof.*

Please type in your full name, as a virtual signature method
Unique ID
Comments
This field is for validation purposes and should be left unchanged.

Please Read:
Some programs are not appropriate for all dogs. Escape The Crate, LLC reserves the right to remove or refuse a dog from any of the Escape The Crate, LLC programs.

No refunds are given for classes missed.

Your Private Training Pet Profile

Dogs are required to be vaccinated against Rabies as per CT State Law. Vaccinations against distemper, parvovirus, hepatitis, parainfluenza and Bordetella are also recommended. Proof of Rabies vaccination is required prior to the first class.

We cannot work with any dog without up-to-date Rabies Vaccination. Please communicate with your instructor if the information on your pet’s profile has changed.

Private Training Pet Profile

Veterinarian Info