Section 1 - Contact Information
First Name *
Last Name *
Street Address *
City *
State *
Zipcode *
Is your mailing address the same as above? *
No Yes
If no, what is your mailing address? Please include City, State, and Zipcode
Primary Phone Number *
Alternate Phone Number
Email Address *
Confirm email
Section 2 - Animal Information
What is your dog's name? *
Please select your dog's gender *
Female, Intact
Female, Spayed
Male, Intact
Male, Neutered
How old is your dog? *
Does your dog have any special medical needs? Please write "none" if there are no special needs. *
Does your dog have any special behavioral needs or any sort of restrictions? For example "no cats - will harm", "hates children", or "only eats their food if you pretend to microwave it". Please write "none" if there are no special behavioral needs *
Does your dog have any food allergies? Please list them or type 'none' if there are no allergies. *
What size category does your dog fall under? *
XS, 1lb-15lb
S, 15lb-30lb
M, 30lb-55lb
L, 55lb-80lb
XL, 80lb-100lb+
Has your dog ever acted aggressively? If yes, please explain with as much detail as possible. *
Has this animal ever bit or broken the skin of a human or another animal? *
No Yes
If yes, what date did the bite occur? Please include who was bit, details that lead up to the bite, and any other bite history.
Is your dog current on their rabies vaccination? *
Owner must inform the trainer if there has been exposure or possible exposure to dog diseases. If there is knowledge dog(s) have been exposed or potentially exposed to disease(s) dog(s) may be turned away from services for the health and wellbeing of all dogs in training. Signs of illness; include but are not limited to vomiting, coughing, gagging, sneezing, reverse sneezing, diarrhea. Please describe the health of your dog. *
Please describe your training goals? *
In addition to your training goals, do you have a desire to work on any of the following? Select all that apply *
Potty Training Sit Rest & Relaxation Down Place Crate Training Touch Recall Leash Skills Leash Skills in Public Paw High Five Crawl Roll Load up (vehicle entry) Threshold boundaries/release
What cues does your dog currently execute successfully? *
Board & Train Clients Only: Is your dog on medications? Please list each medication, the dosage given, and what time you normally administer.
Board & Train Clients Only: Please list the brand name/type of dog food you feed, how many meals per day, and measurement per meal
Is there anything else you'd like to share? *
Section 3
Where did you hear about our training? *
Are you currently working with a dog trainer or have you worked with one in the past? *
Please list a backup emergency contact for your dog, other than yourself. (First Name, Last Name) *
Emergency Contact Phone Number (Please include area code) *
Please provide your dog's primary veterinary clinic name *
Veterinary Clinic Phone Number *
Section 4 - Signatures & Contract
Please attach a photo of your driver's license or other valid photo ID. (Please do not attach a photo of your dog here) *
Please type "AGREE" to indicate that you understand Dog Training with Kasey through Animal Empowerment League does not use aversive tools such as ecollars, shock collars, choke collars, or prong collars. *
Please type "AGREE" to indicate that you understand payment for training is due upfront. No training sessions will be scheduled until payment has been received. *
Please type 'AGREE' to indicate that you understand payment for individual sessions includes one hour of in-person or virtual instruction with Kasey. You should expect to be available for this time to learn with your dog. You can expect to learn the processes used to teach them and insight into their body language to strengthen the bond with your dog. *
Please type "AGREE" that pricing includes: training treat pouch, treats, clicker, and long line. Additional training supplies may be offered to you at an additional cost. *
Please type "AGREE" to indicate that you understand training is a paid service. Results may vary. *
Please type "AGREE" to indicate that you understand you will receive one free 30-minute consultation call to establish the relationship and determine compatability and/or a starting point for training sessions. *
Please type "AGREE" to indicate that you understand under North Dakota law, animals are considered "property". If, at any time, the welfare of the animal is in question, law enforcement may become involved. It will be up to authority discretion what happens with the animal. *
Please type 'AGREE' to indicate that you understand any muzzle training is for cooperative care purposes. Muzzle training with Kasey through AEL is a life skill building opportunity, not for addressing major safety concerns. *
Please type "AGREE" that your dog has not been deemed 'dangerous' or 'aggressive'. *
Please type "AGREE" to indicate that you understand all training clients must show proof of vaccination for the following: rabies, distemper/parvo, bordetella. You can send these via text image to 507-400-3221. *
Please type "AGREE" to indicate that you understand the cancellation policy: Definitions: Cancellation: No service was rendered. Reschedule: Service was moved to an alternate day and time. Refunds: CLIENT has 24 hours from the moment of payment to request a full refund. Any cancellations made more than 72 hours prior to the scheduled appointment are eligible for a 50% refund. CLIENT may opt to reschedule their booking in lieu of a 50% refund. Cancellations require a 72 hour cancellation notice, via text message, to DOG TRAINER. Cancellations made less than 72 hours prior to the appointment time will not be refunded. *
Please type "AGREE" to indicate you understand the rescheduling policy: Rescheduling: Sessions may be rescheduled to a later date and must be used within 6 months from the date of purchase. CLIENT may reschedule up to 2 times within a 6 month period. Appointments rescheduled by DOG TRAINER will not count towards client reschedule limit. *
Please type "AGREE" to indicate that you understand this agreement is governed by North Dakota law. *
Type "AGREE" here to indicate that your electronic signature and photo ID serve as if you had physically signed this form and is legally acceptable. *
By signing, you ("Client") consent to Kasey entering your home and/or property to conduct training, if applicable. You release Animal Empowerment League, its agents, directors, officers, staff, volunteers, and all others associated with Animal Empowerment League from any and all demands, lawsuits, causes of action, either at law or in equity, or other claim which may arise from: personal injury to client and/or client's family members resulting in any biting, scratching, or allergic reaction by the animal; any illness or disease which may be transmitted from the animal to the client and/or client's family or any other animal which is maintained and kept by the client; any property damage caused by any act of the animal. The Client certifies that the information provided, written and verbally expressed, is accurate and truthful. *
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