subject_line
Private Training Registration Form
Participant Information
First Name
*
Last Name
*
Mailing Address
*
Email Address:
*
Phone Number:
*
Your preferred method of contact:
*
Email
Phone
Dog's name
*
Dog's Breed:
*
Dog's Gender:
*
Male - Intact
Male - Neutered
Female - Intact
Female - Spayed
Birth Date (if known)
+
Are there other dogs in the household?
*
Yes
No
If yes, please provide breed, age, gender of all other dogs in the household:
Did your dog join your family as:
*
A puppy (under 20 weeks old)
An adolescent (older than 20 weeks old)
An adult
Did you get your dog from:
*
A breeder.
A shelter or animal rescue.
Litter you bred yourself.
A neighbour or friend.
The internet (Kijiji or similar).
Other.
Other.
Is this your first dog?
*
Yes
No
1. Has your dog ever been in a fight with another dog? If NO, move to Question #2:
*
Yes
No
Do you know what the breed of the other dog involved was?
Was either dog injured seriously enough to require veterinary care?
*
2. Has your dog ever bitten a person, either accidentally or intentionally? If NO, move to Training History.
*
Yes
No
The person who was bitten was:
An adult male.
An adult female.
A male child.
A female child.
A male teenager.
A female teenager.
An elderly male.
An elderly female.
Other Information
Have you taken classes with your dog before or has your dog worked with a private trainer? If YES, please list classes taken/training done, where and when.
*
When walking or training your dog what type of collar/harness have you used (check all that apply):
*
Flat buckle or clip collar
Head Halter (Gentle Leader, Halti or similar)
Martingale (flat collar with section of chain)
Front clip body harness (Easy Walk or similar)
Back clip body harness
Check chain (chain with two rings)
Prong collar
Pinch collar
Electronic collar
Other
Other
Do you have an invisible fence or electric fence on your property?
*
Yes
No
How often does your dog get fed meals?
*
Morning only.
Evening only.
Morning and evening.
What does your dog typically have for meals?
*
Commercial kibble.
Commercial canned dog food.
Commercial raw diet.
Homemade raw diet.
Home cooked.
Other.
Other.
What is your dog's typical eating habit?
*
Eats everything right away
Eats some of his food and walks away
Picks at his food and eats very slowly
Often - more than 50% of the time - refuses to eat anything unless hand fed
Generally, how much exercise does your dog get on a daily basis?
*
Please describe the behaviour problem you are hoping to address:
*
Do you have any other information you wish to include?
Thanks for taking the time to complete this questionnaire. I will be in touch with you within 48 hours. Dawn
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