Client's Name:

Enter today's date:

  -- mm/dd/yy

As the legal owner of dog referenced below I do hereby waive and release K9 Behavior Counselor, Terri Bullers from any and all liabilities of any nature.

I agree to take complete responsibility for the actions of my dog before, after, and during class and consultation sessions.

At no time will the instructor of the class or consultation session be liable or responsible for the action of myself, my dog or any other person who accompanies me in my class or consultation session.

Note: By selecting "Yes" you agree to waive and release K9 Behavior Counselor, Terri Bullers from any and all liabilities of any nature.

  Yes No

Dog Information:

Name
Breed
Age
Sex	Male Female
Weight