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Home
About
Training Methods
Services and Pricing
Blog
Contact
Owner Information
Name
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email Address
*
Home Phone
(###)
###
####
Cell Phone
(###)
###
####
Work Phone
(###)
###
####
Names and ages of all family members living with your dog
Other pets living in your home
Is this your first dog
Yes
No
How did you hear about Wagline Dog Training?
Dog Information
Dog Name
Breed or Breed Mix
Age
Male or Female
Male
Female
Spayed or Neutered
Spayed
Neutered
Unspayed/Unneutered
Where did you get your dog?
Did you adopt your dog from a shelter or rescue?
Shelter
Rescue
How old was your dog when you got him or her
*
Has your dog gone to training before?
Yes
No
If you have done training where and for how long
Name of current veterinarian
Date of last vet visit
Describe any health or medical issues your dog may have
What brand of food do you feed your dog?
How often do you feed your dog?
What is your dogs activity level?
Low
Average
High
Excessive
How often do you play with your dog?
How do you exercise your dog?
Walks, runs, in yard, at dog park, etc.
How often and how long do you exercise your dog?
Please complete the following behavior information to allow us to best assist you and your dog:
Check all that apply and note the three most troublesome to you and your family in the box below the choices:
Barking
Jumping Up
Housetraining
Stealing an item
Not coming when called
Doesn't listen
Nips at children
Biting
Reactive to other dogs
Pulling on leash
Shy
Destructive Chewing
Uncontrollable Behavior
Hyperactive
Chases people, children, other animals (in a circle)
Growls
Nips at adults
Other
Three most troublesome behaviors
If you go near or touch your dog's food dish when he is eating, will he show his teeth, growl or snap?
Yes
No
If your dog has a toy, bone or piece of food in his mouth and you try to take it away, will he show his teeth, growl or snap?
Yes
No
If you grab your dog, does she ever show her teeth, growl or snap?
Yes
No
If your dog steals something (i.e. sock, food, tissue), will she show teeth, growl or snap?
Yes
No
If your dog is on your bed, couch or other favorite resting spot and you try to make him move, will he show teeth, growl or snap?
Yes
No
Does your dog, otherwise housetrained, ever urinate on your bed, furniture or other objects?
Yes
No
How many times?
If your dog is lying on the floor and you roll him onto his back to clip her nails or check her for ticks, will she show teeth, growl or snap?
Yes
No
Have you ever been concerned with your dog's interaction with other dogs?
Yes
No
If yes please explain
Have you ever been concerned with your dog's interaction with a relative, friend or stranger?
Yes
No
If yes please explain
When you arrive home does your dog roll onto his back and urinate when he greets you?
Yes
No
If you discipline your dog, does he duck, crawl on his belly or roll on his back and urinate?
Yes
No
Yes No When you take your dog to an unfamiliar place is she fearful, does she hide, cower, shake or try to leave?
Yes
No
Is there anything else we should know about you or your dog?
WAIVER, ASSUMPTION OF RISK AND AGREEMENT TO INDEMNIFY AND HOLD HARMLESS I understand that a dog training session is not without risk to myself, members of my family or guests who may be in attendance, or my dog because some of the dogs to which I (we) 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 Lisa McEvoy, Wagline Dog Training, Brighton, its employees, owners and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but not without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of any such damage or injury while attending any training session or other function with Wagline Dog Training. In consideration of and as inducement to the acceptance of my application for training assistance, I hereby agree to indemnify and hold harmless Lisa McEvoy, Wagline Dogs Training, its employees, owners and agents from any and all claims, or claims by any member of my family or any other person accompanying me to any training session or function of Wagline Dog Training as a result of any action by any dog, including my own. I understand that the there are potential risks to myself, members of my family or guests, or my dog, when working on aggression issues or other behavior problems. I understand payment is non-refundable once a session or package of sessions begins. NOTE: Must be 18 years of age or have parent or legal guardian's signature. All persons that will be handling a dog in class must agree to this waiver. Please type your name to indicate that you agree:
Thank you!
