Eagle Valley Kennels New Client Form
Please fill out the form entirely, one for each dog.
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Dog's Registered Name
*
Include Titles
Dog's Call Name
*
Dog's Date of Birth
*
/
MM
/
DD
YYYY
Last Rabies Vaccination
*
-
MM
-
DD
YYYY
Breed
*
Color
*
Height
*
In Inches
Weight
*
In Lbs.
What service(s) are you interested in?
*
Puppy Headstart
Private Lessons
Ultimate Companion B/T
Boarding
Basic Obedience Group Class
Please select any that apply to your dog
*
Dog Aggressive
Small Animal Aggressive
Human Aggression
Food Aggression
Social with people
Social with dogs
Dog selective
Barrier Reactive
Shy/Anxious
Reactive
Picky Eater
Environmental Allergies
Food Allergies
Fearful
Diet
*
If signing up for training: Please describe your dog training/trialing goals:
*
Any additional comments, questions or needs of your dog:
*
How did you hear about us?
*
Internet Search
Facebook
Groomer
Vet
Friend
Other
If referred by a friend, please tell us who so we can thank them:
Submit
Should be Empty: