Group Class Questionnaire

Please provide the following information so we can help your dog become the perfect family companion.

* = 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:

How did you year about me?

Would it be OK to publish class photos of you and your dog on Facebook and/or my website or newsletter? YesNo

Phone:

Veterinarian:

How/when acquired?

Dog's breed:

Name of breeder/shelter:

Sex of dog: MaleFemale

Age:

Spayed/neutered? YesNo

Current on shots/titers?

Date of last shots:

Your Dog Challenges: JumpingHousetrainingChildrenMeeting DogsPossessiveCatsChewingBiting/nippingAggressionSubmissive urinationCome Here!GrowlingLeash walkingBarkingSeparation anxietyOther (describe below)

Other Dog Challenges:

What do you hope to accomplish with your dog? Tell me your goals:

Yes! Send me FREE monthly training tips!

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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After pressing Submit, you will receive a copy of this questionnaire in your email.