Primary Contact Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Are there other members in the household besides yourself?*No, I live alone.Yes, I have an adult partner.Yes, I have a family with children.Names and ages of all members in your household:*Home Address:* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your Best Phone Number:*Your Email:* Does your dog pull on the leash?*YesNoSometimesIs your dog reactive to other dogs while on leash?*YesNoSometimesIs your dog reactive to people while on leash?*YesNoSometimesIs your dog timid/shy?*YesNoDependsUnder what circumstances does your dog behave timidly/shy?*Has your dog spent time socializing with other dogs?*Yes, often.No, never.OccasionallyIs your dog comfortable around children?*YesNoDependsUnder what circumstances is your dog NOT comfortable around children?*Does your dog jump on people?*YesNoDepends on the personDoes your dog steal food or other items in the home?*YesNoSometimesDoes your dog come when called under any/all conditions?*YesNoDoes your dog let you groom them and handle their feet?*YesNoSometimes/Depends on the personHas your dog ever been in a dog fight?*YesNoPlease describe the circumstances in which your dog was in a fight with another dog.*Has your dog ever bitten a person?*YesNoPlease describe the circumstances in which your dog bit another person or yourself.*What are your primary goals for training?*Are you committed to attending a mandatory follow-up training session, intended for the entire family?*How did your hear about our training program?*You may take this opportunity to ask us any questions or include any comments:PhoneThis field is for validation purposes and should be left unchanged.
