Canine to Five Application

Your Information:

Primary Owner/Contact:*
Address:*
Day Phone:
-
Eve Phone:
-
Email:*
Confirm Email:
How did you hear about us?
Which program are you applying for?
Names and ages of all humans living in the house:
Names, ages, and breeds of all other animals living in the house:

Your Dog's Information:

Dog Name:*
Breed:
Date of birth (approx):
Weight (approx):
Sex:
Has your dog ever nipped/bitten a person?*
If yes, describe incident and damage to person:
Has your dog ever nipped/bitten another dog?*
If yes, describe incident and damage to dog:

Medical History:

Veterinarian:
Vet Phone:
-
Vet Address:
Does your dog have any health problems we should know about?
Does your dog have any food allergies or sensitivities?
If yes, describe allergies/sensitivities:
Does your dog have a history of GI issues?
If yes, describe issues:

Prior Training:

Does your dog have any prior training?
Training done:
Describe any other training:
Names of previous trainers/training businesses previously used:
What does your dog know?
Describe any other commands/tricks that your dog knows:
Have you ever used any of the following training methods or tools?

History:

Where did your dog come from?
How long have you had your dog?
Is this your first dog?
Why did you choose this dog?
What type of food do you feed your dog?
Brand of food:
How many times a day is your dog fed?
Is your dog free-fed?
What time(s) is your dog fed?
Does your dog get "people food"?
What type of treats, cookies, and/or chews does your dog get and how often?
Is your dog allowed on furniture?
Percentage of time indoors/outdoors:
Hours left alone:
Where is your dog kept when no one is home?
How often is your dog exercised?
How is your dog exercised?
What are your dogs favorite toys?
What are your dogs favorite activities?
What do you like best about your dog?
How does your dog typically respond to new people?
Comments (responses to new people):
How does your dog typically respond to new dogs?
Comments (responses to new dogs):
What training goals can we help you accomplish?
Specialty Program applications: describe in detail any specific behavior problems you want to address...
What you have tried to solve the problem (please be specific)?
Is there a specific trainer whom you'd prefer to work with?
Is there anything else you think is important for us to know?
Type the characters you see in the picture below
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