Dog Training Questionnaire SP
Owner's Name
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First Name
Last Name
Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Please list ages of all humans currently residing in the home.
*
Please list all other species of animal residing in the home.
Are you comfortable with and capable of carrying out the physical tasks associated with these training sessions?
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Name of dog.
*
Age of dog.
*
Breed of dog.
*
Gender of dog.
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Male
Female
Is the dog spayed or neutered?
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Yes
No
Has your dog received the following vaccines?
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DA2PP
Bordetella
Rabies
None of the above
When did they receive each of these vaccines?
*
What Veterinary Clinic were these vaccines administered at?
*
Please upload proof of vaccines.
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If proof of vaccines have not been uploaded to this questionnaire, proof will be emailed within 48 hours of my first training session.
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Yes
No
Does this dog currently have any medical concerns or conditions?
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Yes
No
If yes, please explain.
Has this dog had any medical concerns or conditions in the past?
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Yes
No
If yes, please explain.
Does this dog have any dietary restrictions/allergies?
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How long have you owned this dog?
*
Where did you get this dog from?
*
Has this dog received any previous training?
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Yes
No
If yes, what trainer did you use?
If yes, why did you involve a trainer?
If yes, how long were you involved with the trainer for?
If yes, when did you involve a trainer?
How does this dog react when meeting new people?
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How does this dog react when meeting other animals? Please specify for dogs, cats, and wildlife.
*
What behaviour(s) does this dog do that you wish they didn't?
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When did you first notice these behaviours occurring?
Have there been any recent changes to the behaviour?
How often do these behaviours occur?
Are you able to anticipate when the behaviour is likely to occur?
Please describe several instances when these behaviours occurred. Please give as much information as possible.
Do you use any tools or items to help with training this dog? (Choke chain, prong, bark, e-collar, electric fencing, etc.)
*
What are you hoping to gain by attending these session?
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What times work best in regards to booking training sessions? (Weekends, evenings, mornings, etc.)
*
How did you hear about this program?
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Facebook
Instagram
X
Our website
At our centre
At an event
Other
Other:
Contact me concerning upcoming Events and Fundraiser
*
Yes
No
I would like to receive a copy of your quarterly newsletter.
*
Yes
No
Participant Waiver & Agreement Form for Private Obedience
I understand that The Humane Society of Kitchener Waterloo & Stratford Perth (HSKWSP) reserves the right to refuse, cancel, or terminate any training session, at our discretion, if a dog or owner’s behaviour poses a risk to safety or disrupts the learning environment.
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Yes
No
I understand that refunds will not be given for any reason, if training sessions are cancelled.
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Yes
No
I promise to notify HSKWSP if my dog is exhibiting signs of illness i.e. vomiting, diarrhea, lethargy, coughing etc, prior to arriving to for my training session.
*
Yes
No
I acknowledge that my puppy (if under 5 months of age at start of class) has received at least their first set of vaccines, including Kennel Cough, at least 1 week prior to attending class training. I acknowledge that my dog (if over 5 months if age at start of class) is fully up to date on vaccines, including Kennel Cough, at least 1 week prior to attending class training.
*
Yes
No
I agree to provide an up to date record of vaccinations for my dog 48 hours prior to the start of the first class.
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Yes
No
I understand that staff conducting this training work at the HSKWSP and may have come into contact with animals that are not showing symptoms of an illness/disease. Staff take extreme precaution to ensure minimal risk of disease transmission to other pets. If training sessions are taking place at HSKWSP, I understand that my dog may contract an illness/disease during this visit and I take full responsibility for these risks and understand that the HSKWSP is not responsible for any Veterinary charges associated with any illness or injury my dog may contract/receive during this training session.
*
Yes
No
I understand that staff conducting this training work at the HSKWSP and may have come into contact with animals that are not showing symptoms of an illness/disease. Staff take extreme precaution to ensure minimal risk of disease transmission to other pets. If training sessions are taking place at HSKWSP, I understand that my dog may contract an illness/disease during this visit and I take full responsibility for these risks and understand that the HSKWSP is not responsible for any Veterinary charges associated with any illness or injury my dog may contract/receive during this training session.
*
Yes
No
While our training methods are designed to promote positive outcomes, we cannot guarantee specific behavioural changes, as each dog’s response to training may vary.
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Yes
No
While our training methods are designed to promote positive outcomes, we cannot guarantee specific behavioural changes, as each dog’s response to training may vary.
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Yes
No
Waiver of Liability
I hereby declare that dogs are animals and as such can be unpredictable and have the potential of displaying unwanted behaviors without warning.
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Yes
No
Due to the unpredictability of animal behavior and the risk of working with dogs, on behalf of me and my family, our heirs, personal representatives and executors, we hereby release, discharge, indemnify and hold harmless the HSKWSP and its officers, directors, agents and employees from any and all claims, causes of action, or demands of any nature with my participation in the Dog Training Program, including but not limited to accidents, illness, injuries, or damage to possession/pets or persons.
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Yes
No
I hereby give permission to the HSKWSP to photograph my dog during our participation in the dog training program for use in Centre publications, education, website, and social media or for advertising purposes.
*
Yes
No
I hereby give permission to the HSKWSP to photograph myself & accompanying family members during our participation in the dog training program for use in Centre publications, education, website, and social media or for advertising purposes.
*
Yes
No
Signature
*
Date
*
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Month
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Day
Year
Date
HSKWSP Representative
Date
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Month
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Day
Year
Date
Submit
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