Orientation Packet
Your information is confidential.
Email *
Last Name *
First Name *
Street Address
City *
State *
Zip Code *
Phone Number *
Email Address *
Your Birthdate *
MM
/
DD
/
YYYY
Last 4 digits of your SSN *
Dog's Name
Dog's Age
Dog's Sex
Spayed
Neutered
Female
Male
Dog's Breed or description
Date of Last DAPP, DHPP, DHLPP
MM
/
DD
/
YYYY
Date of Last Rabies Vaccination
MM
/
DD
/
YYYY
Date of Last Bordatella Vaccination
MM
/
DD
/
YYYY
Date of Last Canine Influenza Vaccination
MM
/
DD
/
YYYY
Name of Veterinarian
Veterinarian's Phone number
WAIVER AND RELEASE: I understand that participating in the 4 Paws 2 Freedom dog training programs includes an element of risk. I agree to abide by any decision of an instructor as to my ability to participate in the programs safely. I further assume any and all risks associated with participating in these programs including, but not limited to illness, falls, contact with all participants and dogs, and surface conditions, all risks being understood and appreciated by me and I choose to participate, accepting all risk. I agree to abide by all rules of 4 Paws 2 Freedom. Having read this waiver and knowing these facts, and in consideration of the acceptance of my registration, I hereby for myself, and my heirs, executors administrators, or anyone else who might claim on my behalf, covenant not to sue, and waive, release and discharge the 4 Paws 2 Freedom, volunteers and employees in any way assisting or connected with this program from any claims or liability of any kind whatsoever arising out of my participating in this program, even though the liability may arise out of negligence or carelessness on the part of the persons or parties named in this waiver. I also understand and agree that 4 Paws 2 Freedom may use my name, likeness and pictures of me or my dog, for publicity or promotional purposes, without liability or obligation to me. I consent to such use. *
Annual Evaluation Agreement: Client understands and agrees that as a condition of having graduated from the 4 Paws 2 Freedom Service Dog Course they will follow-up their team training with annual re-certification. If the team no longer lives in the Sacramento, California Region, they are required to return for the re-certification at their expense. Dogs who do not keep up with the yearly re-certification will be removed from the 4 Paws 2 Freedom Service Dog Registry. Clients agree to follow-up calls from 4 Paws 2 Freedom Trainers and/or Client Services personnel to assure dogs are healthy and performing at professional standards. Follow ups will be at one month intervals. *
Would you prefer to be notified through: *
Please list the Email address, Phone or text number you wish us to use. *
Service Dog Microchip, ID Tag and Vaccination Agreement: For the safety of the dogs in the 4 Paws 2 Freedom Program all dogs must be current in their vaccinations against infectious diseases.I understand and agree that for my dog to participate in any 4 Paws 2 Freedom course, they must have current vaccinations against • Distemper • Hepatitis• Leptospirosis • Parvo virus• Parainfluenza • Rabies • Bordatella • Canine Influenzaunless my dogs licensed veterinarian issues a letter stating it would be detrimental to my dog’s health to have such vaccines. A Rabies titer would be needed showing appropriate immunity to participate, graduate and be safe working as a service dog. Puppies must have had at least 1 Distemper/Parvo virus vaccinations administered at least 1 week prior to the start of class.. I also understand that it is important to get my dog returned to me should they become lost. I agree to keep an identification tag with my contact information on it, attached to my dogs collar at all times. Should the identification tag get lost or unreadable, I agree to replace it at once. I also agree that my dog will be microchipped and to keep my contact information current with the microchip company. Service Dogs are required to be licensed and I will keep my dog licensed in the city or county in which I live. *
Photograph Release: I hereby grant to 4 Paws 2 Freedom the absolute and irrevocable right and permission to use, reuse, and publish all pictures of me and/or my dog taken in the course of 4 Paws 2 Freedom business. I fully understand that I hold no control over the use of the photograph (s) of which I am a part. Further, I grant to 4 Paws 2 Freedom, and those who the organization may represent, the right to use my name. I hereby release 4 Paws 2 Freedom from any and all claims and demands arising out of, or in connection with, 4 Paws 2 Freedom, as well as the person (s) who took the photograph (s) *
Standards for Service Dogs in Public: Public Appearance: Dog must always be clean, well groomed, (including clean ears, no mats/weeds/stickers in fur, short nails) and must not have an offensive odor. Behavior: Dog may not sniff floor, people or merchandise. Dog may not solicit attention, visit or annoy any member of the general public. Dog may not disrupt the normal course of business. Dog may not vocalize unnecessarily, and must cease behavior upon command. Dog may show no aggression towards people or other animals. Dog may not solicit, sniff or steal food or other items from the general public Training: Dog is trained to perform at least 3 tasks to mitigate aspects of the client’s disability. Dog obeys the commands of the client, except in cases of intelligent disobedience. Dog works calmly and quietly on harness, leash, or other tether. Dog is able to perform its tasks in public. Dog must be able to lie quietly beside the handler without blocking aisles, doorways, etc. Dog is trained to urinate and defecate on command. Dog stays within one foot of its handler at all times unless the nature of a task requires the dog work at a greater distance. Dog is housetrained. Dog may not get on furniture while working (even small dogs). Dogs must not be carried while working, they must walk confidently on a leash *
Service Dog Vest Agreement: Wearing the 4 Paws 2 Freedom Service Dog Vest is an honor and a privilege. Only dogs who have proven they are well trained may wear the 4 Paws 2 Freedom Colors. When the team can pass the first set of Service Dog Benchmarks (listed below) and with the agreement from the instructor that the team is ready for public access training, you will be issued a 4 Paws 2 Freedom Service Dog in Training vest and your dog may begin wearing it. Once you have received the 4 Paws 2 Freedom vest, your dog is required to wear it anytime he/she is working outside of the home. The exception is if your dog is showing reactive or other inappropriate behavior or if the vest is revoked for any reason. Dogs may not wear vests other than the one provided by 4P2F, unless request is made in writing and approved by the Training Team. Dogs may show no dog reactiveness or signs of aggression and wear the vest, even the Service Dog in Training vest. Dogs showing reactiveness do NOT have public access rights. When you graduate, you will return your In Training Vest for a Service Dog Vest. Vests, service dog patches and documents including the 4 Paws 2 Freedom Identification Card and Certification, and Service Dog in Training letters belong to 4 Paws 2 Freedom and can be revoked at any time for behavior deemed inappropriate by either the dog or the handler. Failure to return vests, service dog patches and documents including the 4 Paws 2 Freedom Identification Card and Certification, and Service Dog in Training letters that have been revoked, will result in a report to the sheriff’s department as stolen property ten days after termination *
Service Dog Spay/Neuter Agreement: Service Dogs as a part of their work need to be able to work and focus on their person without distraction.I understand that for my dog to become a certified Service Dog through 4 Paws 2 Freedom my dog must be spayed or neutered. As a condition of my participation in the 4 Paws 2 Freedom Service Dog Course, I agree that if my dog is currently intact, I will have them spayed or neutered within the next 6 months. *
Policy for Military Base Identification: Students who are receiving service dog training on an active military base will be issued base identification to allow them onto base for the training classes. Students who do not graduate from the class will be required to relinquish their Base ID at the time they leave the 4 Paws 2 Freedom program.I agree to return my Base Identification Card to a 4 Paws 2 Freedom Trainer if for any reason I do not complete and graduate from the 4 Paws 2 Freedom Service dog program. *
Please provide the names and contact information for two individuals who have agreed to be support people to help you and your service dog become a successful service dog team. These are friends, family or loved ones who will support you when you are struggling and be able to take your dog temporarily if needed. These individuals must have access to the assistance dog program 24/7 and agree to provide an immediate and temporary home for the dog should an emergency arise. *
Name of First Emergency Support Person *
Relationship of this person to you *
Phone number of this person *
Email address for this person *
Address for this person *
Name of Second Emergency Support Person *
Relationship of this person to you *
Phone number for this person *
Email address for this person *
Address for this person *
Family Consent Form: My family is aware and is in support of my application to 4 Paws 2 Freedom to train a dog to become my service dog. *
Health Care Team
We are required to contact your health care team and let them know you have enrolled in a service dog class
Name of your Primary Care Physician *
Street Address of Primary Care Physician *
City and State *
Zip Code *
Phone number for Primary Care Physician
Name of your Mental Health Provider *
Street Address of Mental Health Provider *
City and State *
Zip Code *
Phone number for your Mental Health Provider *
By submitting the Orientation Packet you agree to all the terms and conditions within *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy