Canine Potentials Companion Dog Training

Directions

Classes held at

Pampered Pooch Dog Daycare

360.679.8348

Located in the Rolling Hills area south of Oak Harbor. From Oak Harbor take the highway south to Sidney Rd. take a right and then a left onto Allyson, ( the street sign may be missing it is the second street from the left) go past Donald St. and it is the long driveway with the gate on the right,

1537 Allyson. Carol Gannaway 341-0581

Remember proof of vaccinations!

APPLICATION FOR TRAINING

Handler Information
Name	How did you learn about these classes?
Street	¨ Former Trainee
City	¨ Veterinarian
Zip Code	¨ Newspaper Ad
Phone	¨ Flyer
e-mail	¨ Other
Dog Information
Breed	Age: Sex: ¨ M ¨F Spayed/Neutered: ¨ Y ¨N
Name	Veterinarian
	Last Vaccination dates:
	Rabies:
	Bordetella:
	DHPP:
AGREEMENT TO HOLD HARMLESS, WAIVER, AND ASSUMPTION OF RISK I understand that attendance of a dog obedience 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 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 Canine Potentials and CarolGannaway from any and all liability of any nature, for injury or damage which I or my dog may suffer. I expressly assume the risk of such damage or injury while attending any training sessions.
Signature:		Date:

Please help me with some information about you and your dog:

How long have you owned this dog?
Is this your first dog?
Age of dog when you acquired it:
Where did you acquire:
Why did you choose this dog?
How often is your dog excercised?
Describe your dog’s behavior
· around other dogs:
· guests and strangers:
Do you have other dogs at home?
How do they all get along?
What percent of time does the dog spend: Inside?				Outside?
What percent of time does dog spend in the company of other dogs?
Mark the statement that best describes your thoughts about your dog:
q Super, the very best.		q What was I thinking?
q Pretty good most of the time.		Other
Listed below are a few phrases that describe common dog behaviors some of them are more desirable than others from the human perspective. Please check the appropriate box as it relates to your dog.
	NEVER		OCCASIONALLY		OFTEN
Reliably comes when called	q		q		q
House-trained	q		q		q
Likes kids	q		q		q
Rides well in the car	q		q		q
Chases cars, bikes or people	q		q		q
Walks politely on leash	q		q		q
Sits on command	q		q		q
Gets along with other dogs	q		q		q
Lies down on command	q		q		q
Jumps up on people	q		q		q
Steals food or objects	q		q		q
Stops barking when told	q		q		q
Plays fetch	q		q		q
Fearful or shy of w people	q		q		q
w objects	q		q		q
Protective	q		q		q
Accepts grooming/nail clipping	q		q		q
Remains at home alone calmly	q		q		q