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Registration Form
Please use the form below to tell me more about you and your dog
Owner Information
Owner's First Name
Owner's Last Name
Phone
Address
Email
Dog's Information
Dog's Name
Breed
My dog is from a:
Choose an option
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Dog's birthday (or date aquired & estimated age on that date)
Sex
Male
Female
Fixed
Yes
No
Weight (lbs.)
Canine Diet and Health
Does your dog have any medical issues or allergies?
Yes
No
If yes, please explain:
Current Vaccinations: (Items with ** are required for all sessions. Items with * are also required for group classes.
Rabies**
Canine Distemper Virus**
Bortadella*
Canine Parvovirus
Canine Adenovirus 2
Canine Influenza Virus
Canine Parainfluenza
Does your dog recieve any of the following:
Montly Flea & Tick Preventative
Monthly Heartworm Preventative
Dental Chews
Regular Teeth Cleaning/Brushing
Regular Ear Cleaning
Do you give your dog treats?
Yes
No
If No, please explain:
Any Particular Type/Brand
Canine Personality & Behavior
My dog is: (check the 3 that apply the most)
Playful
Excitable
Outgoing
Independent
Shy/Timid
Verbally Sensitive
Physically Sensitive
Stubborn
Agressive
My dog can be: (check all that apply)
Overly Protective
Afraid of thunder
Afraid of loud noises
Fearful of children
Fearful of women
Fearful of men
Fearful of other dogs
Fearful of other animals
Afraid of sudden movements
Food agressive
Toy agressive
When stressed or fearful, my dog: (check the 3 that apply most)
Growls
Shows teeth
Snaps
MIGHT bite
WILL bite
Trembles
Cowers
Freezes
Moves away
Is rarely stressed or fearful
Is never stressed or fearful
My dog has been known to: (check all that apply)
Dig
Climb or jump fences
Frequently bark
Guard toys
Guard food
Jump on people
Mouth or nip
Inappropriate chewing
Chase other animals
My dog plays best with: (check the 3 that apply the most)
By him/herself or No dogs
All dogs
Small dogs
Large dogs
Puppies
Young dogs
Old dogs
A small group
A large group
Has your dog ever bitten a person?
Yes
No
Has your dog ever bitten another dog?
Yes
No
Has your dog ever bitten another animal?
Yes
No
If yes for any, please explain here:
Does your dog have any other behaviors not listed above that I should know?
Yes
No
If yes, please explain
Canine Activities
Which, if any, does your dog know ON COMMAND
Sit
Down
Stay
Focus
Leave-it
Wait
Drop-it
Come (recall)
Loose-leash walk
Heel
Take-it
My dog is: (Check all that apply)
Housetrained
Cratetrained
Obedience trained
Agility trained
Emotional Support
Therapy dog
Service Dog
Hunting trained
Herding trained
Does your dog respond better to:
Hand signals
Verbal cues
Both
Sometimes neither
When home alone, my dog is:
Kept indoors (free roam)
Kept indoors (few rooms blocked)
Kept indoors (in a certain room)
Crate/Kennel/play pen
Allowed to go in & out
Kept outdoors
In an outdoor Kennel
Other
Do you take your dog for walks?
Yes
No
If yes, How often and how far
Do you take your dog to the dog park?
Yes
No
If yes, How often and how does he interact with the other dogs
Canine Motivations - What does your dog LOVE
What kind of food/treats does your dog like?
ANYTHING
Human Food/ Homemade treats
Hard/ Crunchy treats
Soft treats
Freeze-dried treats
Jerkey treats
Liquid treats
My dog is NOT food motivated
What kind of toys does your dog like?
Chew toys
Treat-dispensing toys
Interactive puzzle toys/ feeders
Tennis/ Rubber ball
Flirt pole
Flying discs
Rope toys
Squeaky toys
Stuffed toys
What kind of activities does your dog enjoy?
Just getting attention
Playing with toys
Going outside
Going for a walk
Car rides
Playing with other dogs
Petting/ Rubs/ Scratches
Getting to sniff
How does your dog like to play?
Tug-o-war
Wrestling
Getting chased
Chasing others
Fetch
Hide-and-seek
Do you allow your dog to do any of the following passive activities?
Food filled toys
Treat-dispensing toys
Scatter Feeding
Meaty Bones
Filled tracheas
Dehydrated treats
Scenting
Puzzle feeders
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