Registration

Name:

Tel. No. (H)   (W)   (C)

Email:

Address:

City:    State:    Zip:

Class I am registering for:

Start Date and Time of Class:

Tuition:

Who will be attending class from your family? (names, and ages)

How did you hear about us?

Dog’s Name:    Age:

Breed:    Sex:    Spay/Neutered?

How long have you had the dog?

Where did you get the dog?

Are there children or elderly adults in your home? (give ages)

What do you hope to learn from these classes?

You must complete this questionnaire. Answer "yes" or "no" to each question with regard to all family members.

1. If you go near or touch your dog’s food or dish when he is eating, will he show teeth, growl or snap? Yes    No

2. If your dog has a bone or toy or inappropriate object in her mouth and you try to take it from him, will she show teeth, growl or snap? Yes    No

3. Does your dog guard stolen objects? Yes    No

4. If your dog is on your bed or the furniture and you try to ask him to move or get off, will he show teeth, growl or snap? Yes    No

5. If you need to clip your dog’s nails or groom him or examine for fleas or ticks, does she growl, show teeth or snap? Yes    No

6. How often does your dog meet or see other dogs? What is his typical reaction? (viciously lunges, play bows, hides behind you, growls, barks, fearful, shy etc.)

7. Have you ever been concerned about your dog’s interaction with non-family members? Yes    No

8. How often does your dog meet other people? What is his typical reaction? (viciously lunges, play bows, hides behind you, growls, barks, fearful, shy etc.)

9. When you arrive home, does your dog urinate in submission? Roll on her/his back? Yes    No

10. Have you ever taken your dog to another class? Yes    No

I understand that dog training can occasionally be a risky undertaking for both participants and spectators. In case of any harm, damage or injury that happens or is caused by me, my relatives, my dog or my property during this event, I agree not to hold liable Tracy Haskell, MSW, Peaceful Pack Dog Training, their tenants, invited guests, clients or any of their agents working on their behalf. If I bring children, I agree to supervise them at all times and assure that their behavior does not disrupt events or event participants. I agree that my dog is healthy, current on his/her vaccinations, is free of fleas or other parasites and will not attend class if he/she has been in contact with any communicable diseases within 30 days of these classes. By selecting "I Agree" below and submitting this form, I agree to the above as well as to the Peaceful Pack Policies (click here to review).

Agree:    Do Not Agree: