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*Which class are you interested in: 

How did you hear of us: 

*Your name: 

*Your email: 

Names of other family members: 

*Best number to reach you:: 

2nd best number: 

Mailing Address: 

City: 

State: 

Zip Code: 

*Pooch Name:  

*Breed: 

Color/Markings: 

DOB (if unknown, estimated DOB): 

Where did you acquire your dog: 

How old was s/he when first brought home: 

Gender: 

Spayed or Neutered: 

If you plan to spay or neuter, please
tell us the approximate surgery date: 

If you don't plan to spay or neuter,
please tell us the reasons: 

Veterinarian: 

Date of last vet visit: 

Does your dog have a chronic medical
condition, surgical history, take any
medication, or eat a special diet: 

Is this your first dog as an adult: 

What if any types of dogs have you lived
with in the past - including childhood: 

Are there any other pets living in your home: 

If so, please list: 

If there are children living (or visiting
frequently) in the home, please list their
ages, date of birth, and gender: 

Did you or are you currently
crate training your dog: 

Please describe how and
when you use the crate: 

Have you read any training books: 

If so, which ones, and what did you
like and/or dislike about them: 

Please list and describe any prior training.
Include dates, class type and your level
of satisfaction. Please include any "at-home
training" you have done with your dog: 

If applicable, how did your dog
respond to the training: 

What are some training issues or problems
you are experiencing with your dog: 

Please list your goals for this class: 

Questions or comments: