Group Class Questionnaire

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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