ESA Training agreement

I understand that Heart Dogs NT WILL aim to create a secure, safe and friendly environment for the training of my dog. Heart Dogs NT WILL train my dog in a responsible professional way and will offer me advice on how to maintain the level reached in the course. Heart Dogs NT is not, however responsible for incorrect assertions. *

Owner First Name *

Owner Surname *

Street Address *

City *

State *

Post Code *

Phone Number *

Email Address (non NT Gov or NT Schools email addresses please)(Please check spam folder as you will get an automatic email once you submit this form and future emails may also go there) *

Facebook Profile

prefered Breed or type of dog *

Do you have any illness or allergy that could be detrimental to having a support dog *

If yes above please supply details?

Yes, I agree to abide by Heart Dogs NT Policies and Procedures. I acknowledge that I have read and understood relevant Policies and Procedures that are available at: www.pawsdarwin.org.au . I understand that Heart Dogs NT may make changes to Policies according to Industry standards and I will check this link on a 3 monthly basis.

I understand that there will be a fee payable for the dog i am applying for. *

REMOVAL FROM program should a dog and handler be incompatible of if there are any acts of violence or aggression towards the dog or the trainers. No refund will be given under such circumstances. *

I/ or someone in my family has the following disability/support requirements. *

CLEANLINESS: Owner is responsible for the removal of excrement that their pet is responsible for *

LIABILITY: Owner agrees to indemnify and hold PAWS Darwin Trainer and Trainer’s employees/agents harmless from all liability for any loss, damage or injury to persons, animals or property arising from or related to Owner’s pet. *

Owner agrees that Trainer shall not be liable for loss or damage to animal for any reason unless said loss or damage was a direct result of Trainer’s negligence. *

I understand that it is up to me to compete all public access testing and to abide by NT and National regulations for support dogs. I understand that I need to ensure that I have the Doctors certificates etc required to show that I am eligible for an emotional support/ assistance dog. *

I understand that this means means that Heart Dogs NT expressly disclaims, and I expressly release Heart Dogs NT from, any and all liability whatsoever for any controversies, claims, suits, injuries and/or damages arising from and/or in any way related to: any inaccuracy, untimeliness or incompleteness regarding any and all sessions held with Heart Dogs NT and/or misstatements or misrepresentations made by Heart Dogs NT. *

I understand that Behaviourist/Trainer agrees to exercise due and reasonable care of the Dog while at agreed upon locations. However, the Behaviourist/Trainer is not liable for loss or damage from disease, death, running away, theft, fire, injury to persons, other dogs, or property by the Dog during or after the term of this Agreement. *

I (the Client) agrees to pay all resulting losses and damages suffered or incurred, and to defend and indemnify the Behaviourist/Trainer, her employees and agents from any resulting claims, demands, lawsuits, losses, costs or expenses, including attorney fees. *

How did you hear about us? *

Badges &/or Logos may be expected to be purchased in certain instances. If a Client ceases their relationship with (or vice versa), these will be expected to be returned to Heart Dogs NT *

Yes, I understand that I am solely liable for any damage to persons, premises, or facilities including places of public accommodation, public conveyances or transportation services, common carrier of passengers, places of housing accommodations, and places of employment caused by that Assistance dog. *

Yes, I (or the alternate handler) shall keep the dog properly harnessed or leashed. I understand that failure to properly harness or leash the dog is entitled to maintain a cause of action for damages in a court of competent jurisdiction under the same laws applicable to other causes brought for the redress of injuries caused by animals. *

Yes, I understand that I must contact the Heart Dog Trainer weekly throughout the duration of the Assistance Dog Training program by Heart Dogs NT Behaviourist’s. *

Yes, I understand that Heart Dogs NT trains Dogs and Handlers for either those seeking to prepare for Assistance Dog accreditation with State or Territory Government’s, or, those seeking training under the Commonwealth Disability Discrimination Act (1992; Section 9.2.c). I will work with Heart Dogs NT Behaviourists at the commencement of training so the course outline can be individualised to my requirements.

Yes, I authorise Heart Dogs NT to administer or seek First Aid and resuscitative care for my dog(s) as determined appropriate by Heart Dogs NT and I agree to indemnify and hold harmless Heart Dogs NT for all and any results thereof AND YES, I also agree that in the case that I cannot be contacted and/or in the event of an emergency, A) I authorise Heart Dogs NT its agents and/or representatives to seek immediate veterinary care for my dog. B) I am responsible for all costs associated with this veterinary care. OR  No, I DO NOT authorise Heart Dogs NT to administer or seek First Aid and resuscitative care for my dog(s) as determined appropriate by Heart Dogs NT and I agree to indemnify and hold harmless Heart Dogs NT for all and any results thereof.

Yes, I authorise Heart Dogs NT to administer treats to my dog and I agree to indemnify and hold harmless Heart Dogs NT for all and any results thereof. AND YES, I will undertake to notify Heart Dogs NT of any food allergies that have developed or pre-existing in my dog throughout the duration of this contract. OR  No, I DO NOT authorise Heart Dogs NT to administer treats to my dog. I understand that by not providing permission here training will not be as effective.

I understand that it is my responsibility to implement what is covered in the training sessions and agree that without training and proper reinforcement, my dog will most likely not learn the desired behaviour

Yes, I understand that my dog (while a current Heart Dogs NT client) must have a current C5 vaccination (and the certificate must be sighted by the Trainer/Behaviourist) and, remain current in their vaccination status throughout my dog’s duration as a client with Heart Dogs NT. *

I understand that my dog and myself may be recorded during training, this recording is used to assist and encourage better training for dogs owners and trainers, and while every effort is taken to avoid faces and conversations the nature of the camera may overlap, i agree that i may be photographed and if i do not want to have footage used with myself in it then i will talk to the instructors and let them know. I understand all efforts to protect privacy will be taken. *

Yes, I understand that full payment of the service is to be paid at the time of the agreed training session start time (and a 48 hour Cancellation Fee applies). Non-payment of fees may result in cancellation of future sessions and active collection of outstanding fees via debt collectors and/or the Australian legal system by Heart Dogs NT. Recovery of monies owed will be at client’s expense. Heart Dogs NT abides by the Australian Competition & Consumer Commission “Consumer Rights & Guarantees”. *

I understand that my Dog must be re-assessed yearly and may involve veterinary certification in addition ongoing while the dogs is active as a service dog. *

I understand the Behaviourist/Trainer will make every reasonable effort to help the Client achieve training and behaviour modification goals but makes no guarantee of the Dog´s performance or behaviour as a result of providing professional dog behaviour consultation. The Client understands that he/she and members of the household must follow the Behaviourist/Trainer´s instructions without modification, work with dog daily as recommended, and constantly reinforce training being given to Dog. *

I understand that Termination may occur if the Client breaches any term or condition of this Agreement. Upon termination in accordance with the foregoing, the Behaviourist/Trainer’s duties shall terminate but all other provisions of this Agreement shall continue in full force and effect. Refunds are issued at the discretion of Heart Dogs NT in this instance. *

I understand that Termination may occur if the Behaviourist/Trainer´s sole judgment the Dog is dangerous or vicious to the Behaviourist/Trainer or any other person or animal, or interferes with the training of other dogs. *

I have completed all of the below required fields. All boxes must be ticked to validate this Training Contract.

Signature of Applicant. Please use your finger on touch screen or click and hold your left button to use your mouse above the line. *

Date *