Dog Training Pre-Enrollment Form "*" indicates required fields Please fill out this form as thoroughly as you can. The more information you include, the more we understand your dog skill level and the goals you have for training. You will receive an initial email confirmation of our receipt of this form. Within 48 hours, you will receive an additional email confirming the details of your requested enrollment(s) and with the goal of getting you and your friend into the best class for you both. As each pet is different, if you wish to pre-enroll multiple pets, please complete and submit this form in its entirety for each pet you wish to pre-enroll.Name* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How did you hear about usName of Dog Age of Dog Breed of Dog Dog's GenderMaleFemaleSpay or Neutered?Please Select OneYesNoHow long have you had the dog? Why are you currently interested in dog training?Describe previous training dog has receivedMedical conditions or injuries past or present?Aggressive toward other dogs? If yes, explainAggressive toward people? If yes, explainHow does your dog react to visitors to the home?Number of dogs interacted with past 3 months What problematic behaviors are you currently experiencing with your dog?What are your training goals for your dog?What activities do you like to share with your dog?Activities prevented from sharing due to dog's behavior?In which of our Training Class(es) are you looking to enroll? (Select all that apply) Puppy Kindergarten Canine Good Citizen Show Handling Therapy Dog Class Puppy Agility Tricks Rally Novice Private Training Basic Obedience Intermediate Obedience Advanced Obedience Trainer preference? If so, who? All dogs who attend classes, including private classes, must be “current” on Distemper/Parvo, Rabies, and Bordetella vaccines. Additional to providing your dog’s vaccination due date(s) below, proof of vaccination via copies of medical records or certificates MUST be provided to the NOPC prior to confirmation of enrollment (please upload those document copies below. Clear photographs and digital PDFs are both considered acceptable). Please also provide your veterinarian's contact information in case we need to clarify your pet’s information with them directly. It remains the pet owner’s responsibility to ensure all necessary information is provided. Upon special request and as a courtesy, the NOPC may contact your veterinarian on your behalf to obtain medical records, however, the NOPC will not be held responsible for the ultimate provision of any medical records from a 3rd party. Any pet whose vaccination status has NOT been confirmed to be “current” by the NOPC 48 hours prior to the start of your first class may not be allowed to participate due their unconfirmed vaccination status.Please understand that If an adult dog becomes overdue for any of these vaccinations, protection is not immediately achieved on the date of vaccination, and there will be a necessary waiting period post-vaccination before they are considered protected and “current.” Specifically, 3 days for Intra-nasal Bordetella, 10 days for Distemper/Parvo (DHP/DHPP), and 28 days for Rabies. Additional to these required vaccinations, we highly recommend the Canine Influenza vaccine as well. If your pet is due for any of these vaccinations mid-enrollment, it is the Pet owner’s responsibility to ensure they are vaccinated before passing their due date and to provide the updated vaccination records to the NOPC no later than 48 hours prior to their next class. The North Oatlands Animal Hospital is happy to assist with these vaccinations if you are unable to schedule elsewhere and meet the timelines.For Puppies - Virginia statute (§ 3.2-6521) requires Rabies vaccinations to be administered by 4 months of age and as such no puppy may be enrolled/admitted for training in violation of this statute. The NOPC requires the Bordetella Intra-nasal vaccine and the 3rd “in-series” Distemper/Parvo (DHP/DHPP) vaccination to be administered by 16 weeks of age to be eligible to participate in ANY group classes. To be very clear, no waiting period post puppy vaccination(s) will be required.I have read, understand, and agree to comply with the specific vaccination requirements as provided above.* I have read, and understand Vaccination History Drop files here or Select files Max. file size: 128 MB. Vaccination Due Dates(please enter from your pet’s vaccination records)Bordetella MM slash DD slash YYYY Distemper/Parvo (DHP/DHPP) MM slash DD slash YYYY Rabies MM slash DD slash YYYY Please select one* I have uploaded my pet's vaccine records for NOPC review and validation. I have NOT or was unable to upload my pet's vaccine records. I agree to email ALL necessary documentation to info@noahvets.com as soon as possible and in accordance with NOPC policy. I need special help with regards to providing my pet’s vaccine records (explain below) Explain* Veterinarian Name Veterinarian Phone NumberI authorize NOPC to contact my veterinarian as necessary.* I authorize Add another dog? Yes No Name of Dog Age of Dog Breed of Dog Dog's GenderMaleFemaleSpay or Neutered?Please Select OneYesNoHow long have you had the dog? Why are you currently interested in dog training?Describe previous training dog has receivedMedical conditions or injuries past or present?Aggressive toward other dogs? If yes, explainAggressive toward people? If yes, explainHow does your dog react to visitors to the home?Number of dogs interacted with past 3 months What problematic behaviors are you currently experiencing with your dog?What are your training goals for your dog?What activities do you like to share with your dog?Activities prevented from sharing due to dog's behavior?In which of our Training Class(es) are you looking to enroll? (Select all that apply) Puppy Kindergarten Canine Good Citizen Show Handling Therapy Dog Class Puppy Agility Tricks Rally Novice Private Training Basic Obedience Intermediate Obedience Advanced Obedience Trainer preference? If so, who? All dogs who attend classes, including private classes, must be “current” on Distemper/Parvo, Rabies, and Bordetella vaccines. Additional to providing your dog’s vaccination due date(s) below, proof of vaccination via copies of medical records or certificates MUST be provided to the NOPC prior to confirmation of enrollment (please upload those document copies below. Clear photographs and digital PDFs are both considered acceptable). Please also provide your veterinarian's contact information in case we need to clarify your pet’s information with them directly. It remains the pet owner’s responsibility to ensure all necessary information is provided. Upon special request and as a courtesy, the NOPC may contact your veterinarian on your behalf to obtain medical records, however, the NOPC will not be held responsible for the ultimate provision of any medical records from a 3rd party. Any pet whose vaccination status has NOT been confirmed to be “current” by the NOPC 48 hours prior to the start of your first class may not be allowed to participate due their unconfirmed vaccination status. I acknowledge the above statement, I have uploaded my pet's vaccine records and I authorize NOPC to contact my veterinarian as necessary. I acknowledge the above statement, but I was unable to upload the required documentation. I agree to provide ALL necessary documentation as soon as possible and in accordance with NOPC policy, and I authorize NOPC to contact my veterinarian as necessary for validation once provided. I acknowledge the above statement but need special help (explain below) Explain * I have read, understand, and agree to abide by the terms of this agreement. Vaccination History Drop files here or Select files Max. file size: 128 MB. Vaccination Due Dates(please enter if known)Bordetella MM slash DD slash YYYY Distemper/Parvo (DHP/DHPP) MM slash DD slash YYYY Rabies MM slash DD slash YYYY Veterinarian Name Veterinarian PhonePlease understand that If an adult dog becomes overdue for any of these vaccinations, protection is not immediately achieved on the date of vaccination, and there will be a necessary waiting period post-vaccination before they are considered protected and “current.” Specifically, 3 days for Intra-nasal Bordetella, 10 days for Distemper/Parvo (DHP/DHPP), and 28 days for Rabies. Additional to these required vaccinations, we highly recommend the Canine Influenza vaccine as well. If your pet is due for any of these vaccinations mid-enrollment, it is the Pet owner’s responsibility to ensure they are vaccinated before passing their due date and to provide the updated vaccination records to the NOPC no later than 48 hours prior to their next class. The North Oatlands Animal Hospital is happy to assist with these vaccinations if you are unable to schedule elsewhere and meet the timelines.For Puppies - Virginia statute (§ 3.2-6521) requires Rabies vaccinations to be administered by 4 months of age and as such no puppy may be enrolled/admitted for training in violation of this statute. The NOPC requires the Bordetella Intra-nasal vaccine and the 3rd “in-series” Distemper/Parvo (DHP/DHPP) vaccination to be administered by 16 weeks of age to be eligible to participate in ANY group classes. To be very clear, no waiting period post puppy vaccination(s) will be required. I acknowledge the above statement and I have uploaded my pet's vaccine records or provided my veterinarian's contact information here. Add another dog? Yes No Name of Dog Age of Dog Breed of Dog Dog's GenderMaleFemaleSpay or Neutered?Please Select OneSpayedNeuteredHow long have you had the dog? Why are you currently interested in dog training?Describe previous training dog has receivedMedical conditions or injuries past or present?Aggressive toward other dogs? If yes, explainAggressive toward people? If yes, explainHow does your dog react to visitors to the home?Number of dogs interacted with past 3 months What problematic behaviors are you currently experiencing with your dog?What are your training goals for your dog?What activities do you like to share with your dog?Activities prevented from sharing due to dog's behavior?In which of our Training Class(es) are you looking to enroll? (Select all that apply) Puppy Kindergarten Canine Good Citizen Show Handling Therapy Dog Class Puppy Agility Tricks Rally Novice Private Training Basic Obedience Intermediate Obedience Advanced Obedience Trainer preference? If so, who? All dogs who attend classes, including private classes, must be “current” on Distemper/Parvo, Rabies, and Bordetella vaccines. Additional to providing your dog’s vaccination date(s) below, proof of vaccination via copies of medical records or certificates MUST be provided to the NOPC prior to confirmation of enrollment (you may upload those copies below. Clear photographs and digital PDFs are both considered acceptable). Any pet whose vaccination status has NOT been confirmed to be “current” by the NOPC 48 hours prior to the start of your first class may not be allowed to participate due their unconfirmed vaccination status. If you are unable to upload your pet's vaccine history, please provide your veterinarian's contact information so that we can obtain this information from them directly on your behalf. All dogs who attend classes, including private classes, must be “current” on Distemper/Parvo, Rabies, and Bordetella vaccines. Additional to providing your dog’s vaccination due date(s) below, proof of vaccination via copies of medical records or certificates MUST be provided to the NOPC prior to confirmation of enrollment (please upload those document copies below. Clear photographs and digital PDFs are both considered acceptable). Please also provide your veterinarian's contact information in case we need to clarify your pet’s information with them directly. It remains the pet owner’s responsibility to ensure all necessary information is provided. Upon special request and as a courtesy, the NOPC may contact your veterinarian on your behalf to obtain medical records, however, the NOPC will not be held responsible for the ultimate provision of any medical records from a 3rd party. Any pet whose vaccination status has NOT been confirmed to be “current” by the NOPC 48 hours prior to the start of your first class may not be allowed to participate due their unconfirmed vaccination status. I acknowledge the above statement, I have uploaded my pet's vaccine records and I authorize NOPC to contact my veterinarian as necessary. I acknowledge the above statement, but I was unable to upload the required documentation. I agree to provide ALL necessary documentation as soon as possible and in accordance with NOPC policy, and I authorize NOPC to contact my veterinarian as necessary for validation once provided. I acknowledge the above statement but need special help (explain below) Explain * I have read, understand, and agree to abide by the terms of this agreement. Vaccination History Drop files here or Select files Max. file size: 128 MB. Vaccination Due Dates(please enter if known)Bordatella MM slash DD slash YYYY Distemper/Parvo (DHP/DHPP) MM slash DD slash YYYY Rabies MM slash DD slash YYYY Veterinarian Name Veterinarian PhonePlease understand that If an adult dog becomes overdue for any of these vaccinations, protection is not immediately achieved on the date of vaccination, and there will be a necessary waiting period post-vaccination before they are considered protected and “current.” Specifically, 3 days for Intra-nasal Bordetella, 10 days for Distemper/Parvo (DHP/DHPP), and 28 days for Rabies. Additional to these required vaccinations, we highly recommend the Canine Influenza vaccine as well. If your pet is due for any of these vaccinations mid-enrollment, it is the Pet owner’s responsibility to ensure they are vaccinated before passing their due date and to provide the updated vaccination records to the NOPC no later than 48 hours prior to their next class. The North Oatlands Animal Hospital is happy to assist with these vaccinations if you are unable to schedule elsewhere and meet the timelines. For Puppies - Virginia statute (§ 3.2-6521) requires Rabies vaccinations to be administered by 4 months of age and as such no puppy may be enrolled/admitted for training in violation of this statute. The NOPC requires the Bordetella Intra-nasal vaccine and the 3rd “in-series” Distemper/Parvo (DHP/DHPP) vaccination to be administered by 16 weeks of age to be eligible to participate in ANY group classes. To be very clear, no waiting period post puppy vaccination(s) will be required. I acknowledge the above statement and I have uploaded my pet's vaccine records or provided my veterinarian's contact information here. Request Phone call from our trainer/staff prior to enrolling?NoYesWaiver & Disclaimer AcknowledgementI, the undersigned, have enrolled myself and my dog in the dog(s) training classes, private consultations, workshops or other related activities (Classes) offered by North Oatlands Pet Center. By signing below, I certify that I have been informed and understand that there is always some unavoidable risk of injury involved when working with animals, especially animals with behavioral issues. I acknowledge that dogs can be inherently difficult to control and that not all dogs will be under control at all times. This could result in the possibility of injury to myself, my dog, my family members, or third parties. Additionally, I have had full opportunity to discuss all concerns I have about the foregoing risks with North Oatlands Pet Center and its authorized representatives. I have also made all inquiries and investigations to my satisfaction related to such risks, including, but not limited to, an examination of the training area (if applicable).* InitialsI hereby accept and assume, without reservation, all risks associated with my participation in the Classes, including, but not limited to: the risks of any and all injuries to myself, my dog and any of my family members or third parties who may attend; the risks that my dog may cause injury to other persons and/or dogs involved in the Classes; and the risks that saliva, water, food, snow and/or other debris may be present in the training area. I have read and understand North Oatlands Pet Center’s Training Facility Operating Policies (separate page) and agree to abide by them.* InitialsAs lawful consideration for participating in the classes, I, hereby waive, release, and agree to hold harmless, North Oatlands Pet Center and their agents, employees and trainers, from any and all injuries, losses, claims and damages to any person or persons of any nature whatsoever.* InitialsI hereby consent to my dog being the subject of the photographs and or audiovisual recording and authorize North Oatlands Pet Center to cause the same to be exhibited for educational purposes as still photographs, transparencies, motion pictures, television, video or other similar media. I hereby release North Oatlands Pet Center, and Michelle Jackson, Trainer, from any and all claims for damages for libel, slander, invasion of privacy or other claim based on use of the above-described material(s).* InitialsI represent that I am at least 18 years of age. If under 18 years of age, signature of adult over the age of 18 is also required. NOPC Training Facility Operating Policies Classes need to be paid for at the time of advance registration to hold an enrollment spot. Registrations sent without payment may not be held if payment is not received within five (5) days. All pet’s enrolled in training must be "current" on vaccinations. Written proof of vaccinations must be provided to NOPC prior to confirmation of enrollment. Dogs are required to be up to date on Rabies, Distemper/Parvo, and Bordetella. We highly recommend Influenza also. Class enrollment space is limited; all enrollments or cancellations occurring less than 14 days prior to the start of classes will be considered final and no credit will be offered. If cancellation occurs more than 14 days prior to the start of class, a credit for the canceled enrollment may only be applied to future classes/private instruction. Make-up classes are not typically available for missed classes. If arrangements are made in advance, the instructor may be able to meet with students before class start time to go over what was missed. Private sessions are also available for an additional fee. If your dog is sick, please do not bring them to class. If you have a question about what is allowed in class, please contact the instructor. You are encouraged to come to class without your dog to see what is covered that day. Dogs in heat are not allowed to attend class. The owner may attend class without their dog. The instructor reserves the right to excuse dogs who show aggression towards people or other dogs. Private sessions may be recommended in these cases. Please be sure to disclose any aggressive tendencies that your dog may have to the instructor prior to registering. Dogs MUST BE ON LEASH on the property. PLEASE CLEAN UP after your dog. PLEASE do not allow dogs to meet in class until the instructor gives permission. Young children (under the age of 12) are not allowed to attend group classes. There will be Junior Training Classes available for youngsters. The children MUST be accompanied and supervised by an adult or parent while participating in class. Parents will not “coach” children from the sidelines. NO PRONGED, ELECTRONIC OR CHOKE COLLARS will be permitted in any classes. Only Tuf-Lock, buckle or flat collars, harnesses or head halters are allowed. A 6 ft. leash is required for all classes except for Show Handling Classes. Show leads will be used. I have read, understand, and agree to abide by the terms of this agreement. Owner's Name* First Last Owner’s Signature* Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY Δ
