Colin's Pack

Client Information

First Name *

Last Name *

Email Address *

Phone Number *

Dog's Name *

Dog's Breed *

Dog's Gender *

Male

Female

Dog's approximate age? *

Dog's approximate weight? *

Primary Problem

Aggressive Towards Dogs

Aggressive Towards People

Leash-Aggressive

Other (you will have the chance to provide a longer explanation below)

Was your dog

rescued from a shelter

adopted from another owner

adopted as a puppy (if so, at what age)

other other

Has your dog always have this problem?

Yes, and it has gotten better

Yes, and it has gotten worse

No, we watched it begin

Other Other

Any event/events that triggered the problem to begin or become worse?

No

Yes Yes

Can you describe the problems you're having? *

Street Address *

Address Line 2

City *

State *

Zip Code *

How you heard about us?

google search

facebook

yelp

referral or other referral or other

Emergency Contact Information

Emergency Contact

Phone Number

Secondary Emergency Contact

Phone Number

Release Of Liability

*I apologize in advance for the legal language. Thank you for understanding.

Client's Name (hereinafter referred to as "The Client")

Dog's Name (hereinafter referred to as "The Dog")

(Note: Colin’s Pack services include but are not limited to picking up, driving, walking, hiking, and dropping off The Dog.)

This agreement is between Colin West and any and all Colin’s Pack employees or representatives, (hereinafter referred to as “Colin’s Pack”), and The Client.

Policies and Procedures:

1) The Client understands while participating in Colin’s Pack services, The Dog may be transported, walked on or off leash, and may have interaction with other dogs, people, and wildlife, including rattlesnakes, and that utilizing Colin’s Pack's services may expose The Client or The Dog to risks of serious personal injury, property damage, and even death, despite Colin’s Pack’s utmost care.

2) The Client expressly agrees on behalf of The Client and The Client’s heirs, executors, administrators, successors, and assigns, Colin’s Pack shall not be liable, and The Client will not sue Colin’s Pack, for any injuries or damages, whether to The Client, The Dog, or The Client’s representatives, if any, arising in conjunction with Colin’s Pack’s services, regardless of whether such injuries result, in whole or in part, from any negligence, act, omission or fault of Colin’s Pack. The Client, on behalf of The Client and The Client’s heirs, executors, administrators, successors and assigns, fully and forever releases Colin’s Pack from any and all claims, present or future, and expressly waives the protection afforded by any statute, including California Civil Code section 1542, which provides a general release should not extend to claims unknown, anticipated, or unanticipated.

3) By signing this agreement, The Client, on behalf of The Client and The Client’s heirs, executors, administrators, successors and assigns, accepts and assumes full responsibility for any and all injuries, damages, (both economic and non-economic), and losses of any type, which may occur to anyone or any entity in conjunction with the participation of The Client, The Dog, and The Client’s representatives, if any, in Colin’s Pack’s services and especially agrees to indemnify and hold Colin’s Pack harmless against any and all such injuries, damages, and losses.

4) The Client authorizes Colin's Pack to take The Dog to a veterinarian in the case of an injury or emergency.

The Client has read the foregoing waiver and release of liability and voluntarily executed this document with full knowledge of its content.

By signing below, The Client fully understands and agrees to the contents of this agreement. The Client understands and agrees that the below electronic signature satisfies any legal requirement that such communications be in writing.

Client's Signature: *

clear

Date * +

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