Class Information

Please indicate the class for which you are registering (SCROLL down to find the correct class):

Pup Kindergarten (01/12) Seminar on this date 6-8:30 PM; Subsequent weekly classes from 6-7 PM.Small Dog Obed (01/12) Seminar on this date 6-8:30 PM; Subsequent weekly classes from 7:15-8:15 PMLevels Obed-8 wk (01/12) Seminar on this date 6-8:30 PM; Thurs. and/or Sat. classes followLevels Obed-12 wk (01/12) Seminar on this date 6-8:30 PM; Thurs. and/or Sat. classes followPup Kindergarten (02/10) Seminar on this date 6-8:30 PM; Subsequent weekly classes from 6-7 PM.Levels Obed-8 wk (02/10) Seminar on this date 6-8:30 PM; Thurs. and/or Sat. classes followLevels Obed-12 wk (02/10) Seminar on this date 6-8:30 PM; Thurs. and/or Sat. classes followPup Kindergarten (03/09) Seminar on this date 6-8:30 PM; Subsequent weekly classes from 6-7 PM.Small Dog Obed (3/09) Seminar on this date 6-8:30 PM; Subsequent weekly classes from 7:15-8:15 PMLevels Obed-8 wk (03/09) Seminar on this date 6-8:30 PM; Thurs. and/or Sat. classes followLevels Obed-12 wk (03/09) Seminar on this date 2-4:30 PM; Thurs. and/or Sat. classes follow

Where did you hear about The Canine Connection?

Owner Information

First Name:

Last Name:

Email Address:

Mailing Address:   

City:   State:   Zip:

Home Phone:   Cell Phone:    Work Phone: (if OK to call at work)

Earliest we can call at home:   

Latest we can call at home:

Pet Information

Dog's Name:  Breed:   

Sex: Male Female       Neutered/Spayed? Yes No

Dog's Age:    Date of Birth (if known):   Age of dog when adopted:

Where did you get your dog?

Veterinarian's Name:

Vaccination status: [Select One] Puppy vaccinations in progress Vaccinations complete including bordetella (canine cough) Vaccinations complete except for bordetella (canine cough) Vaccinations need to be updated Not sure

Does your dog have any current health problems or physical limitations? Yes No
If yes, please describe:

Does your dog act differently toward different types of dogs (e.g. big, small, different breeds)? Yes No
If yes, please describe:

Does your dog act differently toward different types of people (e.g. men, women, children)? Yes No
If yes, please describe:

Has your dog ever snapped at or bitten: Another dog ?    An adult?    A child? Don't know
If yes, please describe:

Where does your dog sleep at night?

Where does your dog stay during the day?

Other pets in household (age and type):

What behaviors does your dog already know? (e.g. Sit, Down, Fetch, Tricks)

Please help us help you! Tell us what you most want to get out of training - what are your GOALS for you and your dog?

Other Information

Number of adults and children (ages) in household:

Do YOU have any limitations (physical or other) that will affect your training with your dog? Yes No
If yes, please describe:

Is there anything else we should know about you and your dog?

Acknowledgments and Permissions

REQUIRED FOR GROUP CLASSES:
Please read the Class Policies and input your initials in the box below before submitting your registration.
  I have read the class policies and understand and accept them.
Please initial

REQUIRED FOR BEHAVIOR CONSULTATIONS: (optional for others)
I grant permission for any behavior reports to be shared, verbally or in writing, with my veterinarian.
Please initial  

WAIVER, RELEASE AND INDEMNITY AGREEMENT ACKNOWLEDGMENT AND ASSUMPTION OF RISKS AND HAZARDS
Please read the waiver and input your initials in the box below before submitting your registration.
  I have read the waiver and understand and accept it.
Please initial