Canine Companion Clicker Course

Dog's Name:

Your Name:

Email Address:

Address:

Daytime Phone Number:

Nighttime Phone Number:

Breed:

Age:

Sex:

Male

Female

Male/Neutered

Female/Spayed

Please provide your Veterinarian's information:

May we contact your veterinarian to acquire proof of vaccination for your pet?

yes

no

What would you like to accomplish by bringing your dog to the Canine Companion Class?

1.
2.
3.

How did you hear about Klondike Canine Academy? (Check all that apply)

I'm a current client

My Veterinarian

Someone referred me

Pet Store

Groomer

Facebook

Telephone Book

Breeder

Webpage

Newspaper

Other

If someone referred you, who may we thank?

Where was your dog acquired from?

Age of dog when acquired:

How long have you had your dog?

Has your dog ever attended a training class?

Yes

No

If yes, where:

What do you like most about your dog?

What concerns you most about your dog's behavior?

Please check all behaviors that you are concerned with:

Barking

Jumps up on people

Eliminates indoors

Pulls on leash

Aggressive to humans

Aggressive to cats

Shy/Nervous/Fearful

Destructive Chewing

Does not listen to me

Growls if I try to take a chew/toy away

Aggressive to dogs