Please use this form to enroll in a 2012 One Day Workshop:
In which 2012 class date are you enrolling:
January 21, 2012 February 11, 2012 March 17, 2012 April 21, 2012 May 19, 2012 June 16, 2012 July 21, 2012 August 18, 2012 September 15, 2012 October13, 2012 November 17, 2012 December 15, 2012
Please provide the following contact information:
Name Street Address Address (cont.) City State/Province Zip/Postal Code Country Home Phone Alternate Phone E-mail Repeat E-mail
Please provide information about your dog:
Name Age Sex Male Female Breed: Gender Spayed/Neutered INTACT (not spay/neutered) Has this dog been trained before? YES NO
Please describe your dog:
Mouths or nips people or other pets Bites people or other pets Sometimes appears very aggressive I am a bit afraid of my dog's aggressive behavior I am quite afraid of my dog's aggressive behavior
Select any of the following options that apply to your dog:
Barks more than I would like Pulls on the leash Jumps up on people Charges out of doors Does not come when called Runs away Chases bikes, cars, people or other animals
Select any of the following options that apply:
Does not sit when told Sits, but does not stay Does not lie down when told Lies down, but does not stay Stays most of the time, unless there is a distraction Stays even when there is a distraction
Which of the following training tools have you used?:
Plain buckle collar Choke / Slip chain collar Head Halter Prong / Pinch Collar Body Harness I never have my dog on a leash
How do you currently manage your dog?:
Indoors - let out into fenced yard Indoors - let out in yard with electronic perimeter fence Indoors - let out on chain Indoors - take out for walk on leash Indoors - let out into unsecured yard Mainly outdoors in fenced yard Mainly outdoors in electronic perimeter fence Mainly outdoors in kennel or pen Mainly outdoors on chair Mainly outdoors - running loose Other
Please describe what you hope to gain from attending the Workshop:
Please provide any other information you feel in relevant to entering the Workshop:
Do you understand that the One Day Workshop is designed for dogs that do not have serious anti-social / aggression issues and that you could be asked to leave the class without refund if your dog presents a danger to other people or animals AND do you understand that the enrollment fee is non-refundable, but it is transferable to a future class date if you cannot attend your designated date, if you alert us prior to the beginning of the class you are scheduled to attend?
YES NO Your dog must be vaccinated against Rabies and Distemper/Parvo to participate in the Workshop. Please bring a copy (which you may have back) to the Workshop. By hitting Submit, you acknowledge that you must bring your records to the Workshop and that you have confirmed that your dog is free of external (fleas / ticks) prior to coming to the event.
YES NO
Your dog must be vaccinated against Rabies and Distemper/Parvo to participate in the Workshop. Please bring a copy (which you may have back) to the Workshop. By hitting Submit, you acknowledge that you must bring your records to the Workshop and that you have confirmed that your dog is free of external (fleas / ticks) prior to coming to the event.