*Surname

First Name*

Street Address*

City*

Postal Code*

Telephone Number*

Email*

Area*
—Please choose an option—CitySuburbanRural

Home*
—Please choose an option—DetachedSemi-DetachedTerracedFlat

Garden*
—Please choose an option—YesNo

If garden, please describe

Name

Age

Sex
—Please choose an option—MaleFemaleOther

Relation to You

Name

Age

Sex
—Please choose an option—MaleFemaleOther

Relation to You

Name

Age

Sex
—Please choose an option—MaleFemaleOther

Relation to You

Name

Age

Sex
—Please choose an option—MaleFemaleOther

Relation to You

Name

Age

Sex
—Please choose an option—MaleFemaleOther

Relation to You

Name

Age

Sex
—Please choose an option—MaleFemaleOther

Relation to You

Dog's Name*

Breed*

Current Age*

Sex*
—Please choose an option—MaleFemale

Birthday (month & year)*

Source Where Acquired*

Age When Aquired*

Spayed/Neutered?*
—Please choose an option—YesNo

Age When Spayed/Neutered (If Applicable)

Please detail any other pets in the household including name, species, breed, age, sex, and time in household.

How long have you been a dog owner?*

Have you had expereinece with this breed before?*
—Please choose an option—YesNo

Explain

Have you attended any of the following with your dog?*
Puppy ClassDog TrainingAgilityPrivate Trainer or Boarding Kennel(s)Pet SitterNone of the AboveOther

If "other" please specify

Has our dog attended a veterinary practice for any medical condition other than routine vaccination/check ups?*
—Please choose an option—YesNo

Please give any details

Has your dog been hospitalized for any reason?*
YesNo

Please give any details

Is your dog currently on any medication?*
YesNo

Please give details

Is there any other medical information you feel may be significant?

Name your dog's veterinarian

Name of veterinarian practice

What is your dog normally fed?*

Who feeds the dog?*

When does the dog get fed?*

Who walks the dog?

Is the dog walked on or off a lead?*
OnOffBothWe don't walk

Morning (Weekday)

Afternoon (Weekday)

Evening (Weekday)

Morning (Weekend)

Afternoon (Weekend)

Evening (Weekend)

When does your dog prefer to sleep?

When does your dog actively seek affection?

Is your dog sensitive to your touch or petting?
YesNo

If the answer to the above quesiton is yes, list the body parts that are sesitve.

Will your dog choose to spend time alone, even when you are at home?

Please name your dog's 5 favorite toys, in order of preference.*

Please name your dog's 5 favorite treats, in order of preference.*

Which of the following commands does your dog respond to RELIABLY? Reliably is defined as 8 out of 10 repetitions are correct.*
SitStayLie DownComeLeaveNone of the Above

Lying on beds/furniture
NeverSometimesOften

Jumping Up
NeverSometimesOften

Destructive Behaviour When Left alone
NeverSometimesOften

Wariness of Strangers
NeverSometimesOften

Yawning
NeverSometimesOften

Inappropriate urination/defecation
NeverSometimesOften

Aggression Towards Other Dogs
NeverSometimesOften

Chasing of Cats/Livestock/Wildlife
NeverSometimesOften

Familiar Men
FriendlyNervousShyExcitedAggressive

Familiar Women
FriendlyNervousShyExcitedAggressive

Strangers - Men
FriendlyNervousShyExcitedAggressive

Strangers - Women
FriendlyNervousShyExcitedAggressive

Children
FriendlyNervousShyExcitedAggressive

Traveling in the Car
FriendlyNervousShyExcitedAggressive

Loud Noises (eg. fireworks)
FriendlyNervousShyExcitedAggressive

Please give a brief description of the problem*

When did it start?

Please describe the first episodes

Please describe the last episode

Most serious episode

Adults
NeverSometimesOften

Teenagers
NeverSometimesOften

Children
NeverSometimesOften

Dogs
NeverSometimesOften

Small Animals
NeverSometimesOften

If a bite did occur, did the person or animal require medical attention?
YesNo

What has prompted you to look for behavioural advice now?*

Have you sought advice from any other source about this problem?*
FriendsFamilyVetDog TrainerBehavioristNone of the Above

How have you tried to manage the problem up until now?

What has been the result?

Please give any other relevant information relating to this problem in as much detail as you can

Please indicate which statement best describes the situation between you and your dog now.
—Please choose an option—The problem is not severe but we would like to correct it if we can.The problem is moderate and we would like to correct it if we can.The problem is severe but we will keep our dog whether it can be corrected or not.The problem is severe and we will consider rehoming our dog if it cannot be corrected.

Thank you for taking the time to complete this questionnaire. It will be an immense help in ensuring you get the most benefit from your behaviour consultation.

RELEASE AND WAIVER OF CLAIMS

The undersigned who is a spectator or participant in dog training activities, in consideration of use of facilities covenants and agrees as follows:

GENERAL RELEASE.
The undersigned hereby releases and waives any claims that the undersigned may now or hereafter have against the dog training facility, dog training activity sponsor(s), Tracy Calsavara, her instructors or their assigns from and against any and all liabilities, losses, damages, costs or expenses of whatever kind or nature, including attorney's fees, which the undersigned may incur as a result of any injury to the undersigned or their dog(s), or personal property of the undersigned as a result of the undersigned's activities undertaken at said facility including, without limitation, personal injury and damages thereof including loss of income, earnings, bodily injury, pain and suffering, emotional or mental distress and any and all medical expenses.

ASSUMPTION OF RISK. The undersigned acknowledges and understands that the dog training activities undertaken involve potential risk of personal injury and injury to personal property including dogs which may result from the undersigned's participation in dog training activities. Such injuries may be caused by other participants, the undersigned, facility conditions including, but not limited to, uneven or damaged terrain, the presence of moisture or mud, obstacles and obstructions upon or under the terrain and other natural or man-made conditions which may be hazardous to the undersigned or create hazards to the undersigned's activities. The undersigned further acknowledges that these dog training activities are potentially dangerous and assumes all risk of injury and/or damage which may result from any reason whatsoever thereby.

BINDING EFFECT. The foregoing provisions shall be fully binding upon and shall be effective against the undersigned, its heirs, successors, legal representatives or assigns and shall apply to the actions of the undersigned personally, the undersigned's family, guests, employees or agents.

IN WITNESS WHERE OF, the Agreement is executed this: Date

I hereby agree to abide by the rules of Absolutely Fetching Dog Training, that no dog shall be physically or verbally reprimanded while engaged in any activity sponsored by or affiliated with Absolutely Fetching Dog Training, or while on the premises of Absolutely Fetching Dog Training (with the exception of dogs committing acts of aggression towards people or other dogs). I further understand that any violation of this agreement could lead to the immediate termination of my involvement in the event or activity (including being asked to leave the premises) without refund of any monies paid for that event or activity.

I the undersigned hereby consent to the use of any and all photos taken by Absolutely Fetching to be used in, social media posts, advertisements, promotional material, or for any other purposes Absolutely Fetching so chooses.

I further agree that any photos taken by Absolutely Fetching are the intellectual property of Absolutely Fetching so that Absolutely Fetching and their licensees and assigns may duplicate, distribute, exhibit, or otherwise use the material or any portion of them without restriction, in perpetuity.

I have read and agree to abide by the above statement: Full Name

I understand that the degree to which a dog is successfully trained is a function of the interest, commitment, and cooperation of the owner. I acknowledge and agree that there is no guarantee that my dog will achieve the desired level of training despite the best efforts of the instructor.