Dog Registration Form

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

Your Name(*)
Please let us know your name.

Address
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Suburb(*)
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Post Code
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Telephone(*)
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Other telephone
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Your Email (home is best)(*)
Please let us know your email address.

Dog's name(*)
The Dogs Name field is empty, you must fill this in to Submit the form.

Breed(*)
The Dogs Breed field is empty, you must fill this in to Submit the form.

Age (Yrs/Months)(*)
The Dogs Age field is empty, you must fill this in to Submit the form.

Sex(*)
The Dogs Sex field is empty, you must fill this in to Submit the form.

Weight (kilos)
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Desexed
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At what age did your dog come to you?
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Where from?
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Where did get your dog if chosen OTHER from above?
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As a puppy did your dog go to puppy school?
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How many adults/children live in the house?
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What are the ages of any children?
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What other animals (cats/dogs) live in the house?
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Why did you choose this particular dog?
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Which vets surgery do you usually take your dog for a check up or vaccinations?
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When was your dog last examined/treated by a vet and for what?
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Is your dog on any medication?
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If you answered yes above please explain
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Where is your dog kept when nobody is home
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Is your dog allowed inside when you are home?
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Is s/he is allowed to go on the furniture?
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If you answered YES above explain where he/she is allowed to go.
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Do you use a dog crate for short term confinement?
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Where does your dog currently sleep at night?
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What brand of food do you feed your dog?
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Who does the feeding?
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How many times a day do you feed your dog?
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Do you leave food out for free feeding?
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What type of treats, bones or chew items does your dog get?
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How does your dog get physically exercised?
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How does your dog get mentally exercised?
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Where does your dog go for walks?
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How long are they?
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Who takes your dog for walks?
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How often does your dog get brushed and by whom?
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How often does your dog get bathed or washed and by who?
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Can all family members handle your dog physically
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brush, bathe, trim nails

What is the most amount of time per day does your dog spends without human company?
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Has your dog ever bitten anyone or been in a dogfight? If so, please describe the circumstances:
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What is your dogs reaction to the following?
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Men, Women, Children,Strangers, Crowds, Unfamiliar adult dogs,Unfamiliar puppies, Horses/Cows, Bicyclists/joggers.

What things does your dog dislike the most or gets upset by?
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How would you describe your dogs personality?
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(e.g. shy, fearful, nervous)

What undesired habits, if any, does your dog have?
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If you said OTHER to the above please explain
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Have you tried to change any of these undesired habits?
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What is your dogs favourite activity?
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(e.g. going for walks, playing with other dogs, sniffing, playing games, training sessions)

What is your dogs favourite toy?
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What is your dogs favourite treat?
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Has your dog had prior formal training?
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[e.g puppy school, dog club, training school] If ‘yes’, where, when and for how long

How often do you currently train your dog?
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How, if at all, do you reprimand, correct or punish your dog for unwanted behaviour?
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How, if at all, do you reward and/or motivate your dog for doing something well?
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List the goals that you have for your dog.
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(e.g. to be a socially acceptable family pet, to compete in obedience or agility trials)

What words does your dog respond to?
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(commands, requests, cues)

Verbal Command Please explain
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How often does your dog sit first time when you say ‘sit’?
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When there are distractions, how often will your dog come first time from 10 metres away when called?
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What are the three most important things you would like to change about your dog’s behaviour?
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Which dog training books do you have as a permanent reference?
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What do you think of the importance of being dominant or the Alpha wolf over your dog?

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Who will be responsible for teaching (‘training’) your dog?
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How many minutes a day will that person be willing/able to spend helping your dog to learn?
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Is there anything else about your dog or your circumstances that we should be aware of?
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If you said YES above, please explain.
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If you would like to arrange an in-home assessment and training/behaviour modification session, how soon would you like it?
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Which days of the week would be best for you?
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Which days of the week would be possible for you?
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What times of the day would be best for you? Please choose all that apply.
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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?
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*Appointments on public holidays incur an additional fee of $75.00

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.

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.

Todays Date(*)

Please enter today's date

Please check that all fields marked have been completed, otherwise the form will not be sent.