Consultation Request Form

Please note:

Submission of this form does not guarantee a consultation will be arranged, we will review the application and verify acceptance. If you do not receive a reply within two business days, please contact us at 905-820-4414 or check your spam folder.

Owner's Name*

Email*

Home Phone*

Business Phone

Cell Phone

Street Address*

City*

Postal Code*

Handler's Name*

Handler's Age (if under 16)

Guardian's Name (for handler under the age of 16)

Dog's Call Name*

Breed*

Dog's Birth Date*

Sex of Dog*

Spayed
Yes

Neutered
Yes

Please outline any behavior issues you have noticed (ie dog or people aggression)

Class Date and Time*

Level*

How did you hear about us ?

Preferred Method of Payment*
email money transfercheque mailedcheque dropped off

By checking this box, you agree to the following conditions

The owner represents that he/she is the legal owner of said animal. I certify that I am the actual owner of this dog, OR that I am the duly authorized agent of the actual owner whose name I have entered above. I (we) agree to abide by the rules and regulations as set out by the trainers. I (we) agree to release any and all claims or causes of action which I (we) may in future have against Tri-Mark Canine services, its trainers, sponsors, assistants, volunteers, employees and any or all persons, corporations or organizations which own, lease, occupy, or permit Tri-Mark Canine Services to use any lands or premises for any purpose. I (we) agree to hold the aforementioned parties harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while upon the grounds or near any entrances thereto, and I (we) personally assume all responsibility and liability for any such claim. I (we) will assume financial responsibility for any damage caused by this dog to property or any other person during class time and while arriving and leaving premises.

The email you provided us can be used to contact you re upcoming classes that you may be interested in or to forward notes that you may require. You may unsubscribe at any time.

Tri-Mark_Application  (Download a PDF version of the form)