Dogs Learning Center Dogs Learning Center Dogs Learning Center Dogs Learning Center

Class Registration

Please select the class you are registering for:
Owner Information:
First Name:
Last Name:
Address:
City:
State:
Zip:
Home Phone:
Cell:
Work Phone:
E-Mail:
Please list the names and ages of all family members living with your dog:
Other pets:
Is this your first dog? Yes No
How did you hear about us:
Dog Information:
Dog Name:
Breed or Breed Mix:
Age:
Male or Female? Male Female
Spayed or neutered? Spayed Neutered
Where did you get your dog?
Did you adopt your dog from a shelter or rescue group? Shelter Rescue
At what age?
Has your dog gone to training before? Yes No
If you have done training, where and for how long?
Current veterinarian name:
Date of last vet visit:
Please provide a copy of your most recent vaccination record prior to starting class.
Describe any health/medical issues your dog may have:
What brand of food do you feed and how often?
What is your dog's activity level? Low Average High Excessive
How often do you play with your dog?
How do you exercise your dog? (walks, runs, in yard?)
How often and for how long each time?
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 Pulling On Leash
Jumping Up Shy
Housetraining Destructive Chewing
Stealing Item Uncontrollable Behavior
Not Coming When Called Hyperactive
Doesn't Listen Chases People/Children/Other Animals (circle)
Aggressive Behavior Growls
Nips at Children Nips at Adults
Aggressive Biting Other
Aggressive to Other Dogs

Three most troublesome:
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? How many times? Yes No
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
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 you feel we should know about you or your dog?

WAIVER, ASSUMPTION OF RISK AND AGREEMENT TO INDEMNIFY AND HOLD HARMLESS

I understand that attendance in a dog training class is not without risk to myself, members of my family or guests who may attend, 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 Carolyn Barney, Dogs! Learning Center, 577 Main Street Realty Trust, 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 at Dogs! Learning Center, or while on the training grounds or the surrounding area.

In consideration of and as inducement to the acceptance of my application for training membership in this dog training class, I hereby agree to indemnify and hold harmless Carolyn Barney, Dogs! Learning Center, 577 Main Street Realty Trust, 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 Dogs! Learning Center, or while on the grounds or the surrounding area thereto 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 class begins. Refunds, minus a $50 administrative fee will be given with 48 hour minimum notice prior to start of class

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 initial that you agree:
 
577 Main Street Hudson MA
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