header-b

Dog Registration Form
  1. In-home training/behaviour modification for all dogs, over 4 months of age.

    Items marked * are required fields.

    To help us to help you please fill in as much information as is applicable to you and your dog. Please do not use punctuation marks or commas.

    PLEASE FILL OUT A SEPARATE REGISTRATION FORM FOR EACH DOG

  2. Your Name(*)
    Please let us know your name.
  3. Address
    Invalid Input
  4. Suburb(*)
    The Suburb field is empty, you must fill this in to Submit the form.
  5. Post Code
    Invalid Input
  6. Telephone(*)
    Invalid Input
  7. Other telephone
    The Home Telephone field is empty, you must fill this in to Submit the form.
  8. Your Email (home is best)(*)
    Please let us know your email address.
  9. Dog's name(*)
    The Dogs Name field is empty, you must fill this in to Submit the form.
  10. Breed(*)
    The Dogs Breed field is empty, you must fill this in to Submit the form.
  11. Age (Yrs/Months)(*)
    The Dogs Age field is empty, you must fill this in to Submit the form.
  12. Sex(*)
    The Dogs Sex field is empty, you must fill this in to Submit the form.
  13. Weight (kilos)
    Invalid Input
  14. Desexed
    Invalid Input
  15. At what age did your dog come to you?
    Invalid Input
  16. Where from?
    Invalid Input
  17. Where did get your dog if chosen OTHER from above?
    Invalid Input
  18. As a puppy did your dog go to puppy school?
    Invalid Input
  19. How many adults/children live in the house?
    Invalid Input
  20. What are the ages of any children?
    Invalid Input
  21. What other animals (cats/dogs) live in the house?
    Invalid Input
  22. Why did you choose this particular dog?
    Invalid Input
  23. Which vets surgery do you usually take your dog for a check up or vaccinations?
    Invalid Input
  24. When was your dog last examined/treated by a vet and for what?
    Invalid Input
  25. Is your dog on any medication?
    Invalid Input
  26. If you answered yes above please explain
    Invalid Input
  27. Where is your dog kept when nobody is home
    Invalid Input
  28. Is your dog allowed inside when you are home?
    Invalid Input
  29. Is s/he is allowed to go on the furniture?
    Invalid Input
  30. If you answered YES above explain where he/she is allowed to go.
    Invalid Input
  31. Do you use a dog crate for short term confinement?
    Invalid Input
  32. Where does your dog currently sleep at night?
    Invalid Input
  33. What brand of food do you feed your dog?
    Invalid Input
  34. Who does the feeding?
    Invalid Input
  35. How many times a day do you feed your dog?
    Invalid Input
  36. Do you leave food out for free feeding?
    Invalid Input
  37. What type of treats, bones or chew items does your dog get?
    Invalid Input
  38. How does your dog get mentally and physically exercised?
    Invalid Input
  39. Explain how often you dog gets exercised?
    Invalid Input
  40. Where does your dog go for walks?
    Invalid Input
  41. How long are they?
    Invalid Input
  42. Who takes your dog for walks?
    Invalid Input
  43. How often does your dog get brushed and by whom?
    Invalid Input
  44. How often does your dog get bathed or washed and by who?
    Invalid Input
  45. Can all family members handle your dog physically
    Invalid Input
    brush, bathe, trim nails
  46. What is the most amount of time per day does your dog spends without human company?
    Invalid Input
  47. Has your dog ever bitten anyone or been in a dogfight? If so, please describe the circumstances:
    Invalid Input
  48. What is your dogs reaction to the following?
    Invalid Input
    Men, Women, Children,Strangers, Crowds, Unfamiliar adult dogs,Unfamiliar puppies, Horses/Cows, Bicyclists/joggers.
  49. What things does your dog dislike the most or gets upset by?
    Invalid Input
  50. How would you describe your dogs personality?
    Invalid Input
    (e.g. shy, fearful, nervous)
  51. What undesired habits, if any, does your dog have?
    Invalid Input
  52. If you said OTHER to the above please explain
    Invalid Input
  53. Have you tried to change any of these undesired habits?
    Invalid Input
  54. What is your dogs favourite activity?
    Invalid Input
    (e.g. going for walks, playing with other dogs, sniffing, playing games, training sessions)
  55. What is your dogs favourite toy?
    Invalid Input
  56. What is your dogs favourite treat?
    Invalid Input
  57. Has your dog had prior formal training?
    Invalid Input
    [e.g puppy school, dog club, training school] If ‘yes’, where, when and for how long
  58. How often do you currently train your dog?
    Invalid Input
  59. How, if at all, do you reprimand, correct or punish your dog for unwanted behaviour?
    Invalid Input
  60. How, if at all, do you reward and/or motivate your dog for doing something well?
    Invalid Input
  61. List the goals that you have for your dog.
    Invalid Input
    (e.g. to be a socially acceptable family pet, to compete in obedience or agility trials)
  62. What words does your dog respond to?
    Invalid Input
    (commands, requests, cues)
  63. Verbal Command Please explain
    Invalid Input
  64. How often does your dog sit first time when you say ‘sit’?
    Invalid Input
  65. When there are distractions, how often will your dog come first time from 10 metres away when called?
    Invalid Input
  66. What are the three most important things you would like to change about your dog’s behaviour?
    Invalid Input
  67. Which dog training books do you have as a permanent reference?
    Invalid Input
  68. What do you think of the importance of being dominant or the Alpha wolf over your dog?





    Invalid Input
  69. Who will be responsible for teaching (‘training’) your dog?
    Invalid Input
  70. How many minutes a day will that person be willing/able to spend helping your dog to learn?
    Invalid Input
  71. Is there anything else about your dog or your circumstances that we should be aware of?
    Invalid Input
  72. If you said YES above, please explain.
    Invalid Input
  73. If you would like to arrange an in-home assessment and training/behaviour modification session, how soon would you like it?
    Invalid Input
  74. Which days of the week would be best for you?
    Invalid Input
  75. Which days of the week would be possible for you?
    Invalid Input
  76. What times of the day would be best for you? Please choose all that apply.
    Invalid Input
  77. We try to fit in with your preferred times but if our trainers are already committed elsewhere, what other times Mon – Sun would be possible for you?
    Invalid Input
  78. *Appointments on public holidays incur an additional fee of $75.00
  79. Necessary legalities:

    Please note that we are unable to assist you and your dog with in-home training unless this section has been completed

    I, being over the age of 18 years and the owner and/or the handler of the dog described in this profile form, fully understand and accept that owning and training a dog is not without risk. Therefore, in the event of any human or canine injury, illness, or accident, however caused and to whomsoever caused, I promise and guarantee at all times to hold harmless C.L.E.A.R Dog Training, its principals, owners, assistants, agents, employees, sub-contractors and clients from all liability, damage or injury to any persons, animals or property arising from or related to my dog.
    I also promise that if I do not return any of the training CDs, DVDs or books loaned to me during training then I will reimburse their cost price.

  80. Please type in your name as an electronic signature (*)
    You must fill in your name in order to submit the form.
    By entering your name, you electronically acknowledge reading and understanding the above document.
  81. Todays Date(*)

    Please enter today's date
  82. Please check that all fields marked have been completed, otherwise the form will not be sent.