Dog Training 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

Abode

How Many Children Do You Have?

Have You Ever Owned A Dog? If so, what breeds?

Have You Ever Trained A Dog?

Briefly State What You Hope To Accomplish With Training Sessions:

Dog Information

Dog's Name

Breed

Age

How Old Was The Dog When You Acquired It?

Gender

How Long Have You Owned The Dog?

Has Your Dog Been:

Where Did You Acquire Your Dog?

If acquired from a friend or family member, why was the dog given up?

Why did you get your dog? (Check all that apply)

Fenced Yard?

List any physical/breed characteristics that contributed to your choice for your current dog:

Where Does Your Dog Sleep At Night?

Behavior Problems Of Parents Or Littermates, if Known?

Veterinary Information

Veterinarian

Vet Clinic

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone #

May we contact and discuss health and behavior issues with your veterinarian?

Is Your Dog Current On All Vaccinations Including Rabies?

Please List All Medications Your Dog Is Currently Taking. Please Include Heartworm, Flea and Tick Medications, etc (Write "None" if no current medications)

Please List Any Medical Problems Your Dog Has Had: (Write "None" if no known medical problems)

Is your dog allergic to any types of food or treats?

If Yes, please explain:

Is your dog easily handled by the vet staff?

Has he/she ever had to be muzzled?

Diet and Elimination

What type of food do you feed? (Check all that apply)

Brands of dog food:

How Often is the dog fed?

How much?

At approximately what times?

Does your dog finish all the food at meals?

If no, how long is the food left down?

Does your dog receive other treats/chewies?

If Yes, why types of treats or chewies and how often?

When you give your dog a treat or chew toy, where does he/she usually take it?

Other

Please list 3 of your dogs favorite treats/foods:

Has your dog ever become possessive of his food or a treat?

If Yes, Please describe as much detail as possible:

Is your dog reliably housetrained?

Is your dog crate trained?

Do you have a dog door?

How many times per day does your dog normally urinate/defecate and what are the general times?

Exercise

What type of exercise does your dog get? (If none, then state the reason)

How long does the exercise last/how often is it provided?

On average, how many times a day do you walk your dog and how long does each walk lasts?

Who is normally responsible for exercising your dog?

If walks are provided, what type of collar and leash is being used? (Collar examples: “regular buckle collar,” “head halter,” “body harness,” “pinch/prong collar,” “choke chain.” Leash examples: “6-foot nylon leash,” “retractable leash.”)

Does your dog ever become reactive toward other dogs or people on walks?

If Yes, please describe in detail:

Environment/Lifestyle

List all people including yourself, who live in your household. Please include the ages of children as well:

Who will be responsible for practicing training exercises with the dog?

Does your dog "belong to" a particular household member or everyone?

Do any household members dislike the dog, and if so, why?

Are any household members frightened of the dog, and if so, why?

Is the dog frightened of any household members, and if so, why?

Where is your dog kept when nobody is home?

When you are home, is your dog allowed in the house?

If your dog is not allowed indoors at all, why not?

If your dog is an outdoor dog, would you like him to eventually be able to be indoors?

If indoors, is your dog ever confined (crated, penned) while you are home?

If so, how is your dog confined and for about how long each day?

Reason for confinement?

How many hours per day is your dog without human companionship?

Do you have other pets? If so, what kind, breed, age, sex, neutered?

Three things I like about my dog:

Three things I do not like about my dog:

If your other pet is a dog or cat, how does your dog get along with the other pet?

Does your dog play with toys or play games? If so, describe:

What other activities does your dog enjoy?

Behavior Information/Training

Describe Any Previous Obedience Training:

Level Of Success?

Training methods used (check all that apply):

List organization name and/or trainer's name:

What behaviors does your dog know? (check all that apply):

Others (including tricks):

Check all behaviors that apply to your dog:

Describe in detail any fearful behaviors:

Describe in detail any aggressive behaviors:

Any other unwanted behaviors your dog does?:

List any procedures/training equipment you've used to try to correct the unwanted behaviors:

What would you like help with, in order of importance:

Has the dog ever bitten anyone?

Has your dog ever bitten any animal?

If your dog has bitten anyone or any animal, please describe in detail:

Has medical attention been necessary (for humans or animals) because of any aggressive incident? If so, please describe:

What is your dogs usual reaction when a person he has not met before enters your home?

When was the last time a person unfamiliar to your dog has entered your home?

How Does Your Dog Respond To The Following Tasks?

Trimming Nails?

Giving Pills?

Cleaning Ears?

Grooming?

Bathing?

Patting Head?

Grasp Collar?

Being Lifted?

Describe Unwanted Behavior In Greater Detail:

Describe How Your Dog Reacts To The Following Times When Left Alone:

During The Day:

(ex. Sleeps, Barks, Destructive, etc.)

During The Evening:

(ex. Sleeps, Barks, Destructive, etc)

What Is Your Dog's Reaction To Your Departure?

(ex. Paces, Whines, Barks, No response, etc.)

What Is Your Dog's Reaction To Your Homecoming?

(ex. Jumps up, Urinates, Barks, No response, etc.)

How Does Your Dog Respond To The Following Situations?

When Approached While Eating:

When Approached With Treat Or Toy:

When Dog Is Scolded:

When Dog Is Pushed Off Furniture Or Bed:

When Dog Is Approached While Sleeping:

To People Entering House/Yard:

To Children Or Infants:

While In Car To People Outside Of The Car:

To Other Dogs In Your Home:

To Other Dogs Outside Your Home:

Is there anything else you feel it would be important for us to know?

How did you hear about us?

Name of referring individual, organization or publication:

AGREEMENT TO HOLD HARMLESS, WAIVER AND ASSUMPTION OF RISK

I understand that dog training consultation is not without risk to myself, members of my family or guests who may attend, or my dog.

I hereby waive and release Joe's Dog Training 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