Application Form for Dog Training. Please fill out one form per dog.

Personal Information

Name of Dog Owner (s):
Home Phone:
Work Phone:
Cell Phone:
Address:
City:
Postal Code:
E mail:
Are you a first time dog owner?	Yes No
Emergency Name & Number (other than yourself):
Do you have any physical limitations which may affect your ability to participate in class?
How many people live with your dog:
List names & ages of any children living in the home:
How did you hear about Clever Canines?
If “Referred”, name of person or company:
If “Other”, please list how you heard of us:
I would like to receive future information on upcoming events, activities, seminars, newsletters, reports, and/or updates:	Yes No
Questions, Comments, Concerns:

Canine Information

Special Updates

We have Jump Start dates posted between now and the end of the year! Sign up early to secure a spot.
Check our schedule page for a list of dates, times and current availability.

Name of Dog:
Breed:
Birth date:
Current age:
Weight (in lbs):
Gender:	Male Female
Spayed or Neutered:	Yes No
Age of dog at time of spay/neuter?
Licensed:	Yes No
What age (in weeks) was your dog removed from it's mother:
How old was your dog when you first acquired it?:
Where did you get your dog?
If “Breeder”, what is the name and city of breeder:
If “Other” please explain:
Why did you choose this specific dog and / or breed?:
How many hours per week do you walk your dog on leash?
Please explain any behavioural concerns with off-leash play:
Has your dog ever attacked another dog?	Yes No
If yes, did your dog cause damage (puncture wounds, etc) to the other dog?	Yes No
If “Yes” please explain:
Has your dog ever bitten a person (including you)?	Yes No
If yes, did they break the skin?	Yes No
If “Yes” please explain:
Name of Veterinarian:
Date of last vaccinations:
What kind of food does your dog eat? What Brand?
Any Health problems, Illnesses, Allergies, Limitations:
Have you done training with your dog before?	Yes No
If Yes, give brief description of type of training & outcome
Current behavioral / training issues & challenges:
Have you considered giving up dog due to issues?:	Yes No
What outcomes do you want to achieve from training: