Phone(s): Home _____________ Cell _____________ Work______________
Email: ______________________________ Best Time to Contact:____________
Children Living at home: Y/N Names & Ages: __________________________________________ Does anyone attending have any Impairments? Y/N If Yes please explain:
Due Date of: Rabies vaccination: __________ DHLP-P __________
Why do you want training? ____________________________________________________________________
How did you hear about us? ____________________________________________________________________ Dogs Profile:
1) Has done been Spayed/Neutered? Yes/No
2) How long have you owned the dog?_____________________________________________
3) Where did you obtain the dog? -Ad in Paper -Breeder -Friend or Relative -Pet Store -Stray -Shelter/Rescue -Other:________________________________________________
4) When was the dog last seen by the vet? ___________________________________________ 5) Is the dog on any Medication? What and Why? _____________________________________
6) Where is the dog kept? Circle One
-In House Loose -In House Crated -In Fenced Yard -In Dog Kennel -Tied Outside -Other:___________________
7) Has the dog ever bitten anyone? If so, please describe when and the circumstances. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 8) Has the dog ever been in a fight with another dog? If so, please describe when, how many times and the circumstances ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 9) How does the dog react to: Men: ________________________________________________ Women: _____________________________________________ Children:_____________________________________________ Strangers:____________________________________________ Crowds:______________________________________________ Other Adult Dogs:______________________________________ Puppies:______________________________________________
10) What things upset this dog? ________________________________________________________________________________________________________________________________________________________________________
11) How does the dog react to riding in a car? ________________________________________________
12) How does the dog react to being left alone? _______________________________________________
13) How would you describe your dogs personality? Circle all that apply. -Shy -Friendly -Fearful -Happy -Aggressive -Playful -Nervous -Bored -Hyperactive -Loud -Annoying -Calm -Territorial -Finicky -Jealous -Submissive -Indifferent -Dominant -Extroverted -Dependant 14) What bad habits does your dog have? Circle all that apply.
-Barks/Howls -Chases things -Digs -Chews -Growls -Runs Away -Jumps Up -Gets in Trash -Bites -Wets in house -Begs -Other:______________________________________________________________
15) What commands does your dog respond to? Circle all that apply. -Come-----Don’t Jump -Down-----Drop It -Enough----Fetch -Give---------Heel -Leave it----Let’s Go -Sit-----------Stand -Stay------Stop it -Take it----Wait -Others: _______________________________________________
16) How Often will your dog come when called?
-100% -75% -50% -25% -0%
17) List Activities enjoyed by your and your dog: ________________________________________________________________________________________________________________________________________________________________________________
18) Has your dog earned any titles? What are they? ________________________________________________________________________________________________________________________________________________________________________________ 19) List Future Goals you have for you and your dog: ________________________________________________________________________________________________________________________________________________________________________________
Please provide the following before Class: -Registration Form-Waiver-Payment
Make checks payable to: Einstein’s K-9
When entering the Einstein's K9's grounds...
DO NOT ENTER THE PRIVATE RESIDENCE STRAIGHT AHEAD
>Bare Left on Driveway to Einstein's K-9 Training building.
>Enter the Building that has a BLUE ROOF with a sign that says "Einstein's K-9" on the front.
