Rattlesnake Aversion Training by Natural Solutionsinfo@rattlesnakeaversion.com www.rattlesnakeaversicn.corn

Celt Phone: 760-464-6792

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DOG INFORMATION{ploase circlo 10 indicate whether this wiH be each don's first time noion throuQh Rattlesnake AVersion Traininnor a Re·Tralni

Dog 1 Name Breed Age New or Re-train

Dog :2 Name Breed Age New or Re-train

Dog 3 Name Breed Age New or Re-train

Dog 4 Name Breed Age New or Re-trainPlease name any behavior problems (l.e. Aggression towards people Of animals, etc.) that may affect training

Health problems (l.e. current medications, food allergies, physical handicaps, etc.} that may be affe.cted bytraining .

Training Information(P!ease circle Y or N: if different for (~achdOD. olease indicate):

I have used a bark or shock collar on my dog(s} before: Y N

My dog(s) is leash trained: Y N

My dog(s) has been through obedience training: Y N

My dog(s) has been through Rattlesnake Aversion Training: Y NIf yes, how long 8g07 ...."..."'"'.< ...__ ._<._ By Ifl/I"nn.:." _

My dog(s) has been inoculated with rattlesnake vaccine: Y NIf yes, how long ago? _

My dog(s) has come in contact with a rattlesnake: Y N ?If yes, how long ago?Was he/she/they bitten and envenomated? Y NIf yes, what treatments were given if any? _

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May I thank yon for selce ring me to provide animal management emu training services for your pet. Y (}U have asked me toperform training with your pet named above for purposes of reducing the likelihood that your pet will purposely encounterand approach a venomous rattlesnake. This program is called Rattlesnake Aversion Training. r would like to define myscope of work, the costs, and some of the risks and limitations of this work before we proceed.

Stope of\Vor!,

It is anticipated that I ,.•.·in provide the services specified ill !1U5 agreement with the pens) named. above according to mefollowing scope of work.

l ) J will obtain a history OfYOUf pels age. health and behavior. Based upon the information provided to me in the PC-IHealth and History Questionnaire (above), I might ask need to ask you further follow up questions. Prior 10commencement of this aversion training: II is important rhar you. advise me of any kIlO'.V11 health problems that might makethis training in advised. It is suggested that you have your pet examined by a licensed veterinarian before we begin thiswork to make sure that there are no health limitations that would make lh!s training contraindicated,

2) lwill the necessary for purposes of implementing the aversion training. 'This will includeelectric stimulus collars, leashes and live rattlesnakes.

3) Using rhis equipment 1will train yOU!' pet named above in one session use of behavioral aversive training techniquesto have all aversive behavioral responseto it rattlesnake. Any additional or reinforcement sessions are certainlyrecommended, but are beyond the scope of this agreement.

4) During this training I will advise you of and allow you (() observe the outcome, and then counsel you regardingrecommended follow up reinforcement training that would b ad .•.isable in the future.

Costs and Expenses

I will provide the equipment and services defined in the scope of work above for the fixed fee of'S ...:Deranimalpayable on the date 1 3n1 to perform these services

Limitations and RisksBefore you agree to have me perform the SCOP(" of work outlined above. it is importaur that you understand the limitatio-nsand risks of this proposal, and that you give an informed consent.

1) All behavioral training techniques including tbe work defined in the above scope of work have limitations, including butnot limited to the following major limuaticns,

ajThere may stm be a small risk that your per wiIl encounter and filii ro avoid conract with a venomous reptile.bJ Behavioral rrairung may lose cffecuvencss over time unless reinforced with further rrammg sessions.

1) The specific technique I will use may have the following risks of harm to your pet.ai The venomous reptiles 1.will use in this training will be muzzled. /Ui precautions 'will be taken to ensure the

of your pet, our trainers and the snakes. Although the risk is VERY SMALL, there is still a chance thesnake ,:n11 envenomare and can inflict other injury to your pet.

Conclusion and Agreement to Provide ServicesIfthe above scope of work meets with your approval in light of the limitations and risks involved. J will be very pleased tocommence my work. Please then sign this services agreement below. and upon receipt of the fee for the costs and expenses1 will commence the training,

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Signature.

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