Private Training Registration Form
Please complete all relevant sections
Contact Information
Required
Name
First Name
Last Name
Address
City, Province
Postal Code
Phone Number
Please enter a valid phone number.
Email address
Emergency Contact
Full Name:
First Name
Last Name
Phone Number:
Email:
Canine Information
Required
Dog's Name:
Breed:
Date of Birth (DD/MM/YY):
Sex:
Intact Male
Neutered
Intact Female
Spayed
Colour:
Weight (kgs):
Where did you obtain your dog from?
Rescue/ Shelter
Breeder
Other: Please Specify
How long have you had your dog for?
Please list all other pets in the household:
Canine Medical Information
Current Vet Clinic
Vaccine History
Required
DA2PP (Most recent)
First Booster
2nd Booster
Final booster
Date given: (DD/MM/YY)
Rabies (DD/MM/YY)
Bordetella (DD/MM/YY)
Please attach all relevant vaccine records:
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Diet
What kind of food are you feeding your dog?
How much are you currently giving them?
Please list their eating habits: How many times per day? Are they food motivated? etc..
Please list all known allergies
History & Background
Please list all other human members in the household:
If applicable
Do you have any concerns regarding their relationship with your dog? If yes, please list them:
If applicable
What types of exercise does your dog get on a typical day? (Leash walks, off leash, dog park, daycare, play time, etc..) Please also include approximate duration.
How would you describe your dogs energy level?
Low
Moderate
High
Extremely high
Where does your dog sleep at night?
Where is your dog kept when you are not at home?
How does your dog do in the car?
What type of leash/ collar/ harness are you using?
Does your dog walk nicely on leash?
Has your dog had any other training? (Choose all that apply)
Group Classes
Private Training
Off site trainer
Other
What cues does your dog know? (Choose all that apply)
Their Name
Sit
Down
Come
Stay
Wait
Leave it
Drop it
Place/ bed/ crate
Off
Please list 3 things you wish your dog would learn
Please list 3 things you wish your dog would not do
Please check all behaviors that apply to your dog
Reactive/ Aggressive towards people
Reactive/ Aggressive towards other dogs
Fear Reactive
Separation Anxiety
Destructive Behaviour
Excessive Barking
Jumping
Pulling on leash
Jumping on furniture
Nipping/Mouthing
Chews furniture
Play Biting
Bladder control
Steals food/ objects/ etc
Bolts out of doors/gates
Guards food/ toys/objects
Excessive attention seeking
Eats feces
Stubbornness
Bite history
Selective with certain people
Leash Reactive
Prey Drive
Other undesirable behaviors (Please Explain)
Please describe any other information or concerns that you feel we would benefit from knowing about your dog:
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