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Dogs Name *
Breed
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Attach photo (if desired)
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Age
Date of Birth
Weight
Height
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Gender
Male
Female
Spayed / Neutered?
Yes
No |
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Veterinarian
Vet Clinic Name & City
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Inoculation dates:
Rabies
DHLPPC
Bordetella (Canine cough)
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Is this dog on any medication?
No
Yes |
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If yes, please explain:
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Does this dog have any medical conditions that might interfere with his/her participation in training?
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No
Yes
If yes, please explain:
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How long have you owned this dog?
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How did you obtain this dog?
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Animal shelter
Ad in newspaper
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Breeder
Pet store
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Breed rescue
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Friend or relative
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Other:
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Where is this dog kept? |
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Tied outside
Dog pen
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Fenced yard
In house loose
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In/out
doggie door
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In house crated
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Other:
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Has this dog ever shown aggression to a person?
No Yes
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If yes, please explain:
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Has this dog ever shown aggression to another dog?
No Yes
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If yes, please explain:
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Please check any item below that upsets your dog and explain below.
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Being left alone
Being in a car
Strangers
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Puppies
Adult dogs
Cats
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Children
Men
Women
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Crowds
Loud
Noises
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Other:
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How would you describe this dog’s personality and temperament? Check all that apply:
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Shy
Friendly
Fearful
Confident
Aggressive
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Passive
Nervous
Calm
High Energy
Laid back
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Dominant
Submissive
Indifferent
Curious
Dependent
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Independent
Quiet
Loud
Playful
Bored
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Other:
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What bad habits does this dog have? Check all that apply:
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Barks / Howls
Chases things
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Jumps up
Growls
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Digs
Runs Away
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Chews
Begs
Bites
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Other:
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What commands does this dog respond to?
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Sit
No
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Down
Heel
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Leave it
Lets go
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Stand
Drop it
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Stay
Fetch |
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Other:
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How often will this dog come when you call?
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90% or more
75%
50% 25% or less |
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Has this dog had any prior obedience training?
No Yes
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How much and where:
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Has this dog had any prior agility training?
No Yes
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How much and where:
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Has this dog had any prior conformation training?
No Yes
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How much and where:
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What activities do you and this dog enjoy?
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What titles and/or awards has this dog earned?
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What are your future goals for this dog?
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How did you hear about us?
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Assumption of Risk
I understand that attendance of
a dog training event is not without risk to myself,
members of my family or guests who may attend, or to my
dog, because some of the dogs and equipment to which I
(we) will be exposed may be difficult to control and may
cause injury even when preventative measures are taken.
I hereby waive and release the
owners, instructors, staff, and guests of TVKC and the
facilities where training is conducted, as well as the
owners of the property where any event is held, from any
and all liability of any nature, for any injury and/or
damage which I or my dog may suffer, including
specifically, but not limited to, any injury or damage
resulting from the action of any dog.
I expressly assume the risk of
any such injury or damage while I or my dog may be
attending any training session or club event or while on
the training grounds or the surrounding area thereto.
Signature:
Date:
Typing your name in the field
above constitutes your signature for waiver of liability
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