New Client Training Request Form

New Client Training Request Form
Owner(s)
Phone (home)
Work
(Cell)
E-mail address
example@example.com
Address
City
State
Zip
Dog’s Name
Nickname
Breed
Age
Gender

Sex: MaleFemaleNeutered/Spayed YesNeutered/Spayed No
Veterinary Hospital/Clinic
Is your dog Currently under veterinary Care?

Yes
If yes, please explain:
Who may we thank for this referral?
Is your dog on heartworm prevention?

YesNo
If yes, list product used?
Date of last flea prevention treatment

MonthDayYear
Date
Flea Treatment product used
Please select any of the problems below you’re having with your dog.

Pulling while walkingNot coming when calledSeparation AnxietyDestructive ChewingJumping up on peopleExcessive BarkingJumping on FurnitureEscaping Fence Jumping, etcFearfulRunning offStealing food, objectsDiggingFood guardingChasing people of dogsHouse soilingChasing moving objects bike, vehicle, etcOther
Is there a specific reason/problem or incident that caused you to inquire about training?
How many hours a day is your dog left alone on an average day?
Where is your dog kept when you are not at home?
How does your dog do when left home alone? Fine? Okay? Anxious/distressed? Please describe
What is your dogs behavior like when your return from being away from home?
Has your dog ever participated in Dog Daycare?

YesNo
If yes, what facility did you use?
If he/she got kicked out of daycare please explain why?
Do you socialize your dog? Please describe why you do or do not and provide details on how and where you bring your dog to socialize: (on leash, off leash, parks, stores, etc)
Any problems or challenges when your dog bring your dog places to socialize? Please describe.
Training Program Type: (Check all that you are interested in)
(Not sure what class is for you, consult with the trainer directly before choosing training option)

Board and Train (Your dog boards with us for a period of time & we train your dog)Behavior Modification Board and TrainDay Training (you drop your dog off in the AM & pick up in the PM & we train your dog)Private Lesson Package - 5 LessonsPrivate Lesson Package - 8 LessonsPuppy-AKC Star ClassesBasic Obedience ClassesNovice Obedience ClassesAgility Classes30 Minute Consult with Trainer via phone, zoom or in personOther Specialty Classes
Printed Name of Owner
Date

MonthDayYear
Date
Signature

Clear
(Must be signed and dated by owner)

Please save this form on your computer using your lastname.firstname.dogsname

K9 Kampus Initial Client Training Request Form
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