New Client Intake
Client Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
I would like to receive Safehouse K9's monthly e-newsletter about upcoming class offerings, discounts, and bonus training content.
Name of dog's primary handler, if someone other than yourself:
First Name
Last Name
How would you like to be contacted for follow up?
Call
Text
Email
How did you hear about us?
*
Please Select
Social Media
Internet
Word of Mouth
Other
Dog's name:
*
Male
Female
Dog's age:
*
Dog's breed(s):
*
Are there one or more other dogs in the household?
*
Yes
No
If "yes", please list breed, age, and male/female.
What class(es) are you interested in?
Private session
Group obedience
Group reactivity rehab
Puppy starter package
Board and train
Personal defense dog training
What training issues are you hoping to address?
*
What training have you already done?
*
For this question and the next, your answers will not impact Safehouse K9's willingness to work with you. Your answers simply help us have a good idea of what to expect from your dog. Check any of the following that your dog has done to other DOGS:
*
Lunging (on leash)
Lunging (off leash)
Growling (on leash)
Growling (off leash)
Barking (on leash)
Barking (off leash)
Raised hackles (the fur between their shoulder blades)
Nipping
Biting
None of the above
Check any of the following that your dog has done to HUMANS:
*
Lunging (on leash)
Lunging (off leash)
Growling (on leash)
Growling (off leash)
Barking (on leash)
Barking (off leash)
Raised hackles (the fur between their shoulder blades)
Nipping
Biting
None of the above
Please explain the context for this behavior (if applicable).
If applicable, please describe any other reactive/aggressive behaviour not already covered by the questions above.
Any other relevant information you would like to share:
I HEREBY DECLARE THAT:
*
The answers above are true and accurate to the best of my knowledge and that I have communicated the full extent of my dog's reactive/aggressive behaviour (if any) in my answers above.
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