Dog Class Form

Owner Information

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

Dog Information

Dog's Name*

Breed*

Age*

How Old Was The Dog When You Acquired It?*

Gender*

MaleFemale

Has Your Dog Been:*

SpayedNeuteredNone of the Above

Veterinary Information

Veterinarian

Vet Clinic

Is Your Dog Current On All Vaccinations Including Rabies?*

YesNo

Vaccination Dates:

Rabies:*

DHLP:*

Please List All Medications Your Dog Is Currently Taking. Please Include Heartworm, Flea and Tick Medications, etc*

Please List Any Medical Problems Your Dog Has Had:*

When was the last time your dog went to a vet?

Behavior Information

Please choose the type of training methods you have practiced with your dog *

Positive Reinforcement- Food, Toys, PraisePunishment- Correction Equipment, Alpha Based TrainingMix- Minor corrections and use of treats

Other Description, If Needed:

Behavior Problems:*

General Manners- Leash skills, basic obedience, recallReactivity to People- Barking, lunging or growling at peopleReactivity to Dogs- Barking, lunging or growling at dogsFear- Avoidance, lack of confidence, indoor eliminationAnxiety- stressed when separated or left aloneDestructive Behaviours- Chewing, barking, house training

Describe Unwanted Behavior In Greater Detail:*

Do You Use A Crate?*

YesNo

Does Your Dog Like The Crate?*

YesNo

Has Your Dog Ever Bitten A Person or Animal?*

What days and times work best for your consultation?

Want to join a class?

Note- Puppy classes are only on a demand basis where 6 or more dogs are required to run a class

Class you would like to attend

Port Hardy Puppy Social 10-18 weeks of agePort Hardy Adult Class 5 months +Port McNeill Puppy Social 10- 18 weeks of agePort McNeill Adult Class 5 months +

NO REFUNDS - NO CLASS CHANGES

AGREEMENT TO HOLD HARMLESS, WAIVER AND ASSUMPTION OF RISK

1. 24 cancellation is in effect. Full consultation fees will be forfiet and will be due to North Island Canine.
2. Payment is due in full at the end of the consultation.
3. Payment is accepted in the form of cash, cheque or e-transfer.
4. Initial consultations are subject to a mandatory follow up session within 2-4 weeks to ensure suggested training methods are implemented appropriately.
5. All services have set fees, check website for details.

I understand that attendance of a dog obedience training class or consultations is not without risk to myself, members of my family or guests who may attend, or my dog, because of some of the dogs to which I will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest amount of care.

I hereby waive and release North Island Canine northislandcanine.ca hereinafter referred to as the "Training Organization", its employees, officers, members and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any training session, or any other function, of the Training Organization, or while on the training grounds or the surrounding area thereto.

In consideration of and as inducement to the acceptance of my application for training membership by this Training Organization, I hereby agree to indemnify and hold harmless this Training Organization, its employees, officers, members and agents from any and all claims, or claims by any member of any family or any other person accompanying me to any training session or function to the Training Organization, or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own.

By Clicking The Submit Button You Agree To The Above Terms