Level 1

Level 2

Level 1 & 2

Level 3

Dog Sports

Pet Therapy Training

Private

Name of Owner

Address

Town/City

State

Zip

Home Telephone

Mobile

Work Telephone

Ext.

Fax

E-mail Address

Children / Names and Ages

Dog's Name

Breed

Dog's Age

Gender

Spay / Neuter

Have you owned a dog before?

Have you trained dogs before?

If so, where and when?

Briefly share issues that bring you to class.

What are your goals in class?

Do you have any hearing, visual or physical challenges?

Does your dog have any challenges that may affect training?

Any illness or skin disorder treated by a Vet in the last six months?

What kind of dog food (brand, kibble, canned, other)?

What kind and frequency of exercise does your dog get?

Name of Veterinarians

Date of last wellness check and rabies Vac?

Referred by

Have you read and do you accept the Terms of Agreement?