Clone of Puppy Foundation Course Enrolment Form

Canine Foundation Course Enrolment Form

Fill out the form carefully for enrolment. Your enrolment isn't complete until payment is received.
Owner Details
Your Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Format: 0000 000 000.
Why did you get your dog?

Family CompanionGuard DogCompanion for other dog/sBreeding PurposesWorking DogShow DogTherapy DogOther
Are you, or is anyone in your family, allergic to peanuts?*

YesNo
Please list name(s) for Certificate of Completion*
Please list first names, and in the order in which you wish them to appear, of all those you want listed on your puppy's certificate of completion.
You will receive online access to all course material. Would you also like a printed booklet?*

Yes - printed bookletNo - I am happy with electronic materials only
You will receive your clicker (and printed booklet if desired) at the first practical class, or alternatively you can collect it from Animal Behaviour Coaching in Keith prior. In the interim, please use a word eg "yes" in place of a clicker.
Please list all people who live in your home, including ages of any children.*
Briefly describe any conditions that may impact your training ability.
Dog Details
Dog Name*
Breed*
Date of Birth*

DayMonthYear
Estimate if exact date unknown
Sex*
Date of Last Vaccination*

DayMonthYear
Will be written on your vaccination certificate
Vaccination given*
Will be written on your vaccination certificate
Please upload your puppy's most recent vaccination certificate:

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Please upload a photo of your puppy for it's Certificate of Completion:

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Alternatively, vaccination certificates and/or photos of your puppy can be emailed to us at admin@animalbehaviourcoaching.com.au
If your dog has any medical issues, please describe:
Please describe your dog's interactions with other animals:
What are the main issues you are having with your dog at the moment (select all that apply)?*

No issuesMouthingBitingChewingJumping UpCrying at nightToilet trainingDiggingBarkingUpset when you leaveDifficulty with lead/collarDifficulty brushing/groomingAggression around food/toys/bed
Has your dog shown concern or been worried about any of the following (select all that apply)?*

No concernsOther dogsSudden noisesVet visitsStormsWater or bathingCar travelVehicles or trafficWheeled objects eg bikes, skateboardsVisitorsWalks
Final Thoughts
What would you like to achieve throughout this Course?
Please tell us anything else you think we should know:
How did you hear about the Course?*
Should be Empty:

Canine Foundation Course Enrolment Form

Owner Details

Dog Details

Final Thoughts