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E-Mail:
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Owner/Handler Name:
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Billing Address:
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City:
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State:
Zip:
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Work:
Cell:
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Please complete the following information about
your dog, as appropriate:
**For group obedience classes or prtivate consultations, please
complete items 1-21, and 23-24 below (skip item 22).
**For Dog Care Extraordinaire (Day Care, Boarding, Assisted Care)
please complete items 1-8, and skip down to and complete 22-24. |
| 1. Dog's Name: |
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2. Dog's Gender:
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Male |
Female |
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3. Dog's Age:
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Years |
Months |
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4. Dog Spayed/Neutered:
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Yes |
No |
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5. Dog's Breed (If mixed choose dominant breed):
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6. Dog Acquired From:
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7. Veterinarian:
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| 8. Class or Service Requested |
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| For Dog Care Extraordinaire reservations, please
skip to Number 22. (Obedience/private consult clients, continue
with items 9-24). |
| 9. Add Bonus Bag of Equipment? |
Yes |
No |
(Additional cost) |
| 10. What training and/or behavior modification have
you done so far with this dog? In what class or with what trainer
and where? |
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| 11. List Family Members Your Dog Lives With or Sees
Regularly (If children, list ages; also include other pets): |
1.
2.
3.
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4.
5.
6.
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| 12. Your Training Experience: |
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13. Dog's Personality:
(choose as many as apply) |
Friendly to people
Friendly to other dogs
Overly shy around people
Overly shy around other dogs
Nervous around people
Nervous around other dogs
aggressive towards people
aggressive towards other dogs
Jumps on people
Uses mouth to play
Barks frequently
Snaps or bites |
14. Dog's Environment:
(choose as many as apply) |
Lives in house
Not allowed in house
Has fenced yard or run
Allowed to run free
Other dogs in family
Only dog in household
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| 15. What are your goals for you and your dog? |
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| 16. What do you like about your dog? |
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| 17. What is not so good about your dog? |
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| 18. How does your dog spend his/her day? |
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19. How did you learn of these classes:
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| 20. What Friday date will you be starting in the group
class at 9447 LaPerouse? |
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| 21. Prior to your first Friday class, what are several
day/date/times that would work well for you to do your Quick Start
individual lesson and orientation at our shop, 4191 Taku Blvd.?
(We will contact you to schedule this lesson.) |
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| 22. (Day Care/Boarding/Assisted Care
only) What Dates and Times would you like to reserve (from when
to when)? |
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| 23. Release: |
I register the dog named above and release Canines Unlimited,
Martha Fischbach, Shotokan Karate Club, other instructors and
any other associated entity from all liability for damages or
injuries of any nature that may arise in connection with training
classes or dog care.
I certify this dog has had puppy vaccinations, is immunized appropriately
for health and safety, is in healthy condition, and is not a danger
to other animals or humans. Canines Unlimited has permission to
use, and retains all rights to use any of my comments, photos,
or audio/video materials made for educational, informational,
promotional or commercial purposes, such materials becoming the
property of Canines Unlimited/Martha Fischbach.. I understand
there are no credits, transfers or refunds.
Training classes: Classes are to be completed within the
course time frame for which registered. Classes may be added,
combined, canceled or changed, subject to enrollment. Due to the
flexible nature of class and enrollments, I understand the importance
of being on time to assure my place in class, no reservations.
Additional sections will be added if classes are regularly over
attended.
Dog Care Extraordinaire: Canines Unlimited/Martha Fischbach
has my permission to seek medical or other assistance for my pet(s),
and make any decisions necessary, including life and death issues,
in the event I cannot be contacted or reached to make such decisions.
I will pay all expenses incurred.
I have read, understood and agree with the class and/or dog care
services information, policies and fee structure and agree to
the payment schedule for which registered. I promise to immediately
contact Canines Unlimited/Martha Fischbach with any questions,
comments, or concerns I have about class or boarding/care. (Obedience-Please
list special problems or needs). (Day Care/Boarding-complete #24
below.)
Yes, I agree (must check box)
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24. List special problems or needs(Obedience class
participants):
Dog Care Extraordinaire reservation requests--use this space
to list pertinent information, including: veterinarian, medications/supplements
to be given (schedule); current feeding schedule and food being
fed; behavior considerations (separation anxiety, chews everything,
escape artist, dog or people aggressive, etc.,) allergies, medical/physical
considerations, Add-on options requested, and any other pertinent
information we should have. Include contact information of where/how
you can be reached during your pet's stay, and who will be/is authorized
to drop off and pick up your dog.
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