Request assistance with a dog (& online waiver)

Are you experiencing behavioral issues, or perhaps you’re considering rehoming? Tell us how we can help:

[If you are unable to submit the form, verify that all required fields including the signature have been filled.

Still not working…? Ignore the photo attachment & type your responses, instead of using auto-fill.

Note: After clicking ‘Submit’, the form has ONLY been sent once you see the ‘Thank You’ message

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Facebook:
Our preferred contact method is via Messenger. If you use Facebook please provide:
Link to your Facebook Profile:
In Facebook, click on your logo, then the .... for settings. Copy link
Can you share a link to a recent Facebook posting about your dog's issues:
Go to the post, click .... in top right, copy link
Current Dogs
Example: Dog 1: Name | Age | M/F/Neutered/Spayed | Breed(s)
Where did you get your dog from & how long ago?
Describe your dog’s character
What challenges are you facing and how long have these been going on?
If we are able to provide assistance, what days of the week & times are usually suitable for a phone call

NOTE: The form is not submitted until ALL required fields are completed. If you don't reach the 'Thank You' page, then the form has NOT been submitted!
Photo of your dog (ignore this step if you have form upload issues)
Accepted file types: jpg, png, pdf, Max. file size: 15 MB.
Max file size 15Mb
Dog Training Waiver of Claims
By submitting this form and checking the box below you agree to all of the following terms.
I have requested or accepted an offer of dog training assistance from Chesapeake Safe Harbor & Pitbull Safe Harbor, Inc., a Massachusetts nonprofit corporation, Roger Booth and/or Gabriella Booth, both individuals residing in Massachusetts (all collectively the “Released Parties” and each a “Released Party”).
I understand that dogs vary in their temperaments, and that some dogs are easier to train and manage than others. I further understand that dogs that have suffered abuse or even just inconsistent or uneducated handling can be quite unpredictable. I agree that the effectiveness of training is not totally predictable and that even successful training will not last without consistent, informed handling.
I accept training assistance from the Released Parties, acknowledging that results of training can never be guaranteed, and that the actions of a dog cannot necessarily be controlled even with the best of training and handling.
I hereby waive any claims against the Released Parties and release them from any liability in connection with the training and handling of my dog(s) and in connection with any subsequent behavior of my dog(s). I agree that it is my responsibility to manage my dog(s) appropriately, and to seek additional assistance if I am not able to comfortably handle my dog’s behavior.
AGREE to all of the above terms*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right.
- YES I agree to all of the terms.
Signature - touch the box to leave a mark (required)*
IF this Form submits successfully, you should receive a confirmation email. If you do NOT receive this confirmation, (possibly in your Spam folder), please resubmit the form. Call if you do not receive a response to this form in 3 days, in case the web site never forwarded your message. Call today, if this request is urgent !!
Donations
In order to proceed, please donate to CSH rescue. You can expect that I will provide you with 2 - 3 + hours of my time during a consultation focused on improving your dog's issues. What is a reasonable donation? 1. How much do you value your dog & fixing their issues?! 2. How much is my time & experience worth to you? 3. How much will you donate to help other Chessies in rescue? 4. How much can you afford ?!* *How much have you spent on your favorite hobby/indulgence over the last month? (& remember that fixing your dog can bring life long benefits) Is the answer $50? Is it $75 , $100, or more? : ) Email us if you are experiencing hardship and cannot make any donation, or if the requested $50 is beyond your current abilities. It's ok It's optional, but it's good to talk about any shortfall. Sorry for this request - but $ are needed to run a rescue...
Donation Amount

Facebook:

Current Dogs

Dog Training Waiver of Claims

Donations