New Client Information Form

New Client Information Form
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Dog's Name
Dog's Breed
Dog's Age
Dog's Gender

MaleFemale
Is your dog spayed or neutered?
Tell us about the behavior issues or goals that are prompting you to seek out training.
What is your dog's typical reaction upon meeting a new person? (examples: jumps on them, barks and backs away, lunges, growls, tries to bite, etc.)
Where did you obtain your dog?

BreederShelter/RescueIndividual/Friend/Family MemberFound StrayPet StoreOther
How old was your dog when they came to your home? (With puppies, please state as accurately as possible as age impacts behavior significantly. For dogs brought home as adults, approximate age is fine.)
List any of your dog's food allergies or foods we should avoid bringing into your home.
If your dog has any medical issues, please describe them here.
What brand of food does your dog eat?
What type of exercise does your dog get and how often?
Which cues does your dog already know?

SitDownStayComeLeave ItGo to Crate/KennelTricksOther
Has your dog participated in professional training (classes or lessons) before?
Has your dog ever growled or snapped at a person?
Has your dog ever bitten a person?
Has your dog ever growled or snapped at a dog?
Has your dog ever bitten a dog?
If you answered yes to any of the questions above about growling, snapping, or biting, please explain the circumstances of the incident(s) below, the severity of the bite (if applicable) and whether medical attention was needed.
Do any other animals live with you?
Have any of the other animals in your home ever bitten a person or another animal? (While this may not be relevant for training, we need to have this information before entering your home for our safety.)
What are the best days of the week or times of day for you to have lessons?
Is there anything else you feel would be important for us to know about you or your dog?
PAYMENT: Payment is due prior to each lesson. No refunds will be given for lessons which have already taken place.

LIABILITY: Owner understands that Pawsibilities and Trainer Melissa Childs make no guarantees regarding the outcome of training. Owner understands that Pawsibilities, Trainer Melissa Childs and Trainer’s employees/agents are not responsible and cannot be held liable for any loss, damage or injury to persons, animals or property arising from or related to Owner’s pet. Owner agrees that Trainer shall not be liable for loss or damage to animal for any reason. If pet causes property damage, or bites or injures any animal or person, during or after training, then Client agrees to pay all resulting losses and damages suffered or incurred.

By submitting this form, you are indicating your understanding of and agreement to the policies listed above.
Vaccination Records: We will need a copy of your dog's vaccination records to verify that they are up to date on their rabies vaccine. You may provide that here or at your first lesson.

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