Group Class Questionnaire

  * = required field
 
*Your Name (first & last):

Although there is only one handler per dog, all
household members are encouraged to attend.
*Email:
*Dog’s name:
*Class name:

Class location:
 Ashland
 Medford
How did you year about me?
Would you like to receive FREE monthly training tips?
 Yes
 No
Phone:
Veterinarian:
How/when acquired?
Dog’s breed:
Name of breeder/shelter:
Sex of dog:
 Male
 Female
Birth date and age (if known):
Spayed/neutered?
 Yes
 No
Current on shots/titers?
Date of last shots:
Your Dog Challenges:
 Jumping
 Housetraining
 Children
 Meeting Dogs
 Possessive
 Cats
 Chewing
 Biting/nipping
 Aggression
 Submissive urination
 Come Here!
 Growling
 Leash walking
 Barking
 Separation anxiety
 Other (describe below)
Other Dog Challenges:
What do you hope to accomplish with your dog? Tell me your goals:
Future Classes you’d like to hear about:
 Puppy Play & Train
 Dog Manners I
 Dog Manners II
 Difficult Dog Class
 Tricks & Clicks
 Small Dog Playgroup
 Downtown Dogs
 Dog Behavior 101
 Summer Dog Games
 Other (list below)
Other Future Classes:

Group class refunds will be given up until one week before the first day of class – minus a $10 handling fee. No refunds will be given after that point. Group classes are for healthy, friendly dogs who are current on shots & can work safely around other dogs and people. If your dog has shown intense reactions towards people or other dogs, you are encouraged to take private lessons first. If your dog is disruptive in class, he may be dismissed, but you will be given a partial credit towards a private lesson. If you have questions or concerns about whether your dog is suitable for class, please contact Colleen at 541-601-7601.

I am physically able to handle my dog and assume full responsibility for my dog’s actions and agree to hold harmless Colleen Shanahan & hosting facility.


 I have read, understand, and agree to the above. *

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