Free Your Time Enrollment Form

Today's Date- mm/dd/year*
Date Format: MM slash DD slash YYYY
Email
Name*
First Last
Approximately when did the In Home session take place?*
Please tell me when I met you and your pets. Thank you.
Phone*
Free Your Time Service Choice*
- $180 - FYT2 Free Your Time 2 times (approximately 45 min. each visit) a week, minimum 2 weeks
- $255 - FYT3 Free Your Time 3 times (approximately 45 min. each visit) week, minimum 2 weeks
- $320 - FYT4 Free Your Time 4 times (approximately 45 min. each visit) a week, minimum 2 weeks
- $375 - FYT5 Free Your Time 5 times (approximately 45 min. each visit) a week, minimum 2 weeks
There is a Travel Fee of $1 per mile, to and from, for miles traveled in excess of 20 miles from my home near the University of Memphis on Central Ave.

Animal's Name*
Concerns / Goals*
Please describe your goals regarding me training your pet.
Is your pet on a special or restricted diet?*
- yes
- no
Restricted diet
Please explain diet and/or restrictions
Medical Issues*
Does your dog have any current or long term physical ailments / symptoms?
- Yes
- No
Medications*
Is your pet on any vet prescribed medications, over the counter supplements, essential oils, homeopathic remedies ?
- Yes
- No
Medical Issues, Medications, Supplements
Please tell me about your dog's current special diet, restricted diet, vet prescribed or over the counter medications, supplements and the ailments being addressed.
Please list names, Breed/Gender/Age and sexual status of other pets in your household.
Media Consent: I hereby give permission for names (strictly animals' first names only) audio, videos, photos of my animal(s) captured or obtained during the course of How's Bentley Services through the use of any analog or digital hardware to be used solely for the purposes of How's Bentley and Alan J Turner or associates of How's Bentley / Alan J Turner regarding promotional material, social media, educational material, and all publications or applications, and waive any rights of compensation or ownership thereto. I understand the audio captured on recordings may include my voice.*
- Yes, you have my consent
- Maybe, may we have a discussion before I decide?
- No, you do NOT have my consent
Please type "I agree" in the box below, after reading these terms of services. Thank you. Terms of Service: I do not guarantee specific results, I do guarantee to provide the stated amount of time teaching you about animal friendly methods used to decrease unwanted behaviors, and used to increase wanted behaviors. I will also work with your animals using my definition of animal friendly methods. By typing "I agree" the agreement box above, owner states:"I agree with these terms and will not hold responsible Alan J Turner, How's Bentley, any entity or individual that refers, instructs, assists, owns or provides the physical location, for any injuries, liabilities, damages, or losses incurred or perceived to have incurred, by me, my companion animals, my guests, my family, strangers, or other animals, before, during, and after How's Bentley services".*
Agreement
Terms of Service: Please type "I agree"in the box below, after reading and agreeing to these terms of service as well as the services description in the form. Thank you.Terms: No refunds. I do not guarantee specific results, but do guarantee to provide the stated amount of time teaching you about animal friendly methods used to decrease unwanted behaviors and to increase wanted behaviors. I will also work with your animal using my definitions of animal friendly methods. There is a travel fee of $1 per mile, to and fro, my home near the university of Memphis Central ave campus. All sessions must occur within 60 days of the previous session to receive package pricing. By typing "I agree" in the box below enrollee states "I agree with these terms and will not hold responsible Alan J Turner, How's Bentley, any entity or individual that refers, instructs, assists, owns, or provides the physical location, for any side effects, injuries, liabilities, damages, or losses incurred or perceived to have incurred by me, my companion animals, my guests, family, strangers, or other animals, before, during, and after How's Bentley services."*
Terms of Service
Parking Instructions? Gate code? New address since the Consultation? Anything you want to tell us?
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whistlecome.com How's Bentley Animal Friendly Behavior and Training / Canine Specialty

March 15, 2021

Free Your Time Enrollment Form

Before you decide on FREE YOUR TIME services, I’ll need a New Client Form and one in-home session with you and your pet/family so you can meet me and I can meet you, your pet, and learn of your goals.

Step 1 of 2

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