Admissions Form For Service Dog Initial Assessment Consultation Application Form - Service Dog Initial Assessment We will first review your application and email to confirm details within 48 business hours of your application. Please email firstname.lastname@example.org if you don't hear from us within 48 hours; but check your spam folder first! Owner InformationFirst and Last Name(s) of Owner(s)*Street Address*City*Province*Postal Code*Phone*Email* Enter Email Confirm Email Name of Your Vet / Vet ClinicHow did you hear about us?Select from ListOnline SearchClickertraining.comReferralWalk-byFacebook/TwitterVeterinarianOtherDog InformationProgram*Service DogDog's Name*Dog's Breed*Dog's Current Age*Has your dog behaved aggressively towards people?YesNoPlease describe the aggressive behaviour towards people:*# of incidents of aggression towards people:*Please enter a number from 0 to 100.The most severe incident involved:*Running AwayBarking and GrowlingLunging Towards People, No ContactClothing NippedSkin Nipped, No MarkBite, Skin BrokenBite, Multiple BitesSevere Bite, Person Required Medical AttentionHas your dog behaved aggressively towards dogs?YesNoPlease describe the aggressive behaviour towards dogs:*# of incidents of aggression towards dogs:*Please enter a number from 0 to 100.The most severe incident involved:*Running AwayBarking or GrowlingLunging Towards Dogs, No ContactDog Fight, No DamageDog Fight, Dogs InjuredDog Fight, Dogs Required Veterinary TreatmentHas this dog attended training before? If so, please elaborate (name of school/trainer, methods used, outcome of training):Handler Disabilities*Mobility/PhysicalVisionHearingCognitive/LearningPsychiatricInvisible (includes chronic pain/fatigue/dizziness issues)OtherPlease select the family to which the handler's disabilities belongDoctor's Letter*Does the handler have a letter from their doctor recommending a service animal? Type Yes or No.If No, Why?Do you wish your dog to be trained in Public Access?*UnsureYesNoDo you understand the laws ad regulations regarding service animals in Ontario?*UnsureYesNoWhy would you like to train your own service animal?*Any additional notes or comments for us to know?Waiver, Assumption of Risk and Hold Harmless It is my understanding that notwithstanding the exercise of due care and control of the attending dogs whether on my part, those of the other owner/handlers and employees of When Hounds Fly, these obedience classes are not without risk, not only to myself, but also to family or guests who may attend as well as to my dog. I do hereby indemnify and release When Hounds Fly, it’s landlord, employees, owners and agents from any and all liability of any nature, for injury or damage that I; my dog; members of my family or guests may suffer, including specifically, but not limited to, any injury or damage resulting from the action or inaction of any dog or its owner or handler, or from the action or inaction of the landlord, When Hounds Fly or their employees, owners or agents, whether arising from negligence or any other reason or cause whatsoever and I expressly assume the risk of any such damage or injury while attending any training session or function of When Hounds Fly, either on the training grounds or the area thereto surrounding. In consideration of, and as inducement to, the acceptance of my application for training membership in this obedience class of When Hounds Fly, I hereby agree to indemnify and hold harmless, When Hounds Fly, its landlord, employees, owners and agents from any and all claims, suits, injuries, debts, demands, or charges of any nature or kind whatsoever which may be brought by me, or claims by any member of my family or other person accompanying me or my dog to any training session or function of When Hounds Fly, or while on the grounds or the area thereto surrounding, as a result of any action or inaction by any dog, including my own, or its owner or handler, or from the action or inaction of When Hounds Fly, its landlord, employees, owners or agents, whether arising from negligence or any other reason or cause whatsoever. I acknowledge that I have read and fully understand the terms and provisions of this Waiver, Assumption of Risk and Agreement to Hold Harmless and that I freely, voluntarily and unconditionally set my hand heretoBY CHECKING THE BOX YOU ACKNOWLEDGE YOUR ACCEPTANCE AND UNDERSTANDING OF THIS WAIVER* I AGREE SAFETY OF YOUR DOG MY DOG IS SAFE WITH OTHER DOGS AND PEOPLE AND HAS NOT HURT A PERSON OR A DOG. (FOR PRIVATE LESSONS REGARDING AGGRESSION, LEAVE UNCHECKED) VACCINATIONS* I AM RESPONSIBLE FOR ENSURING MY DOG IS UP TO DATE ON ALL VACCINATIONS PRIOR TO ATTENDING CLASS.