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Dog Training Registration Form

CLASS:


Application Date:     Email:

Owner:     Phone:

Address:

City:   State:   Zip:

Dog's Data         To attend class your dog must be 16 weeks old or older by the first class.

Name:   Breed:   Gender:   Age:

Current Rabies Vaccine?     Current Bordetella?     Current Distemper Vaccine?

Veterinarian:

Common behavioral issues (please check all that apply to your dog)
House soils Chews Jumps up Doesn't Come Fights
Barks Pulls on lead Shy Digs Aggressive

If "Aggressive" was checked please provide brief history:


Other problem notes:


Corrections given to date:


Age of dog in Years when obtained:     From:

Litter behavior:

House training method:

Other training:

Have you attended training classes before?     Where:

Is this dog a house pet?     Exercise schedule:

Goals for this class:


List any medical concerns:

Dog's medications:

Diet:     Feeding schedule:

Family Data

Adults in household:     Children in household:

Occupations:

Other pets:

Previous pets:

IN CASE OF EMERGENCY PLEASE CONTACT:

Name:     Phone:


Payment must be made and application must be signed before classes start Date
_______________________________________________________________________ ____ / ____ / __________
Signature (Parent or Guardian if under 18) Date

          
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