Dog Training Evaluation

Owner Information

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Area CodePhone Number

E-mail*

How Many Children Do You Have?*

How Did You Hear About Us?*

Dog Information

Dog's Name*

Breed*

Date of birth*

Date

Age*

Gender*

MaleFemale

Has Your Dog Been:*

SpayedNeuteredNone of the Above

Where Did You Acquire Your Dog?*

How old was your dog when you got them?

How old was your dog when they where spayed or neutered?

Where Does Your Dog Sleep At Night?

Veterinary Information

Vet Clinic*

Phone Number

Area CodePhone Number

Is Your Dog Current On All Vaccinations Including Rabies?*

YesNo

Please List All Medications Your Dog Is Currently Taking. Please Include Heartworm, Flea and Tick Medications, etc

Please List Any Medical Problems Your Dog Has:

Briefly State What You Hope To Accomplish In This training:*

Behavior Information

Has your dog had any professional training?*

YesNo

Describe Any Previous Obediance Training:

Behavior Problems:*

Describe Unwanted Behavior In Greater Detail:

Describe How Your Dog Reacts When Left Alone:

During The Day:

What Is Your Dog's Reaction To Your Departure?*

What Is Your Dog's Reaction To Your Homecoming?*

Do You Use A Crate?*

YesNo

Does Your Dog Like The Crate?*

YesNo

Please Give Information Regarding Fear Or Anxiety In Your Dog:

Describe Situations Where Your Dog Appears Fearful And/Or Aggressive:

Is Anyone In Your Family Afraid Of Your Dog? If So, Please Describe:

How Does Your Dog Respond To The Following Situations?

When Dog Is Pushed Off Furniture Or Bed:*

When Dog Is Approached While Sleeping:*

To Strangers Outside Of The House:*

To Other Dogs Outside Your Home:*

To People Entering House/Yard:*

To Children Or Infants:*

To Other Dogs In Your Home:*

Has Your Dog Ever Bitten A Person?*

YesNo

Has Your Dog Ever Bitten A Dog?*

YesNo

Has Your Dog Ever Been Reported To Animal Control For Biting?*

YesNo

Other animals inside the home?*

YesNo

List other animals in the home.

Client acknowledges that the DOG(S) behavior now and in the future is solely Client responsibility. Client is voluntarily engaged in training as an activity with knowledge of the known risk and other risks that may result from DOG(S) participation in training, including but not limited to injury, death, or property damage from disease, stray dogs, running away, other dogs in training, other animals or injury, death or property damage caused by DOG(S) to other dogs, animals or persons.

Assumption of risk:

If DOG(S) causes property damage or bites or injures another dog, animal or person, including but not limited to the RELEASED PARTIES, during or after the term of this agreement, Client agrees to assume full responsibility and liability for any injury, death or property damage. Client agrees to pay all resulting losses and damages suffered or incurred, and to defend, indemnify and hold harmless the RELEASED PARTIES from any and all resulting claims, demands, lawsuits, losses, costs of expenses, including attorney’s fees and veterinarian cost.

Release of Liability:

Client releases RELEASED PARTIES from all liability to the Client and Clients representatives, guardians, successors, assigns, heirs, children, and next of kin for all liability, claims, damage, or demands for personal injury, death, or property damage to the Client or DOG(S), arising from or related to this agreement or to participation in training, whether the injury, death or property damage occurs during or after the term of the agreement.

Client acknowledges that their dog is up to date with all shots and is NOT under the care of a veterinarian.

By Clicking The Submit Button You Agree To The Above Terms

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