Release of Information Form Release of Information At Your Service Dog Training LLC (“At Your Service”) endeavors to create a training environment that feels safe, supportive, and honest for you, and your dog. We are committed to treating all Clients with respect, sensitivity, and privacy. We also recognize that the nature of training service dogs appropriately, sufficiently, and with best practices for clients may require some degree of disclosure – as by definition a service dog or service-dog-in-training identifies its handler as having a disability. Further, to support Client training goals, we may need to communicate with Client’s healthcare provider (with Client’s permission) or Client’s dog’s veterinarian to train the dog in the best possible way. Please read this form carefully and indicate your agreement to the terms. Please get in touch with questions. Your trust and comfort are very important to us! Thank you. Name* First Last This agreement is between CLIENT (named above) and At Your Service Dog Training, LLC.Please indicate your agreement to the terms.* I agree1. By signing below, Client gives permission to At Your Service, including trainers, students, assistants, independent contractors, affiliates, etc., to discuss Client and Client’s disability or other condition/s, including written or oral communications about Client’s disability or medical condition/s with the following persons to the extent that At Your Service deems reasonably necessary to accomplish service-dog goals: • Client’s medical doctor, psychotherapist, and other healthcare professionals • Veterinarians, trainers, students, interns, and other dog professionals • Businesses and their employees at locations where At Your Service may train Client’s dog (e.g., for public access) Please indicate your agreement to the terms.* I agree2. At Your Service believes that electronic documentation is an incredibly useful training tool, and Client understands and agrees that Client and Client’s dog may be videotaped or photographed during lessons or consultations to enhance Client’s training skills. Such photographs or videos, including Client’s and Client’s dog’s likeness, image, voice, appearance, and written communications, along with Client’s and Client’s dog’s name, may be used by At Your Service for website, social media, promotion, publicity, or other digital or written materials. Please indicate your agreement to the terms.* I agreeBy typing my name and the date below, I hereby state and affirm that I have carefully read this document, asked any questions I have, understand every provision and their ramifications, agree to be bound by the same, have had the opportunity to seek the advice of legal counsel, and knowingly and voluntarily enter into this agreement without reservation. Name First Last Date Date Format: MM slash DD slash YYYY
