TRAINING QUESTIONNAIRE & CONTRACT Step 1 of 4 25% TYPE OF TRAININGClass Date MM slash DD slash YYYY Trainer OWNER INFORMATIONName: Dog Name: Breed: Age: Sex: Neutered/Spayed: Color: Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Day Phone:*Evening Phone:Cellphone:Email* Vet Name: Vet Office & Phone:Obtained dog from? At what age? DOG’S LIFESTYLEMy dog spends most of the time: Inside Outside In a normal week, how often will you work with your dog? My dog is with humans ? hours/amount of time per dayHow much and what type of exercise does this dog get daily? (please be specific): Describe the General Behavior of your Dog:In your house: In your yard: In your vehicle: At the park: Reaction to Strangers: Reaction to Children: Has your dog ever bitten a person or dog: yes no If yes, please describe the circumstances: Check the following problems you would like to correct: Reactivity toward people Reactivity towards dogs Digging House breaking Jumping on People Getting on Furniture Fence Jumping Excessive Barking Destructive Chewing Hyperactivity Behavior Getting into garbage Car Sickness! Does your dog have a crate? yes no If so, are you utilizing the crate? How is the dog in the crate? Please check any of the problems you're having with your dog. Is not housebroken. Mounts people or objects. Urinates when excited/ afraid. Is aggressive towards dogs. Is a nuisance barker or whiner. Play bites. Does not come when called. Bolts through open doors. Guards toys, food, objects, etc. Guards space. Stresses easily. Pulls on leash. Sniffs at or eats from counter tops. Has separation anxiety. Growls at family members. (If yes explain when and why.) yes no Growls at family members. Growls at people outside of the family. (If yes explain when and why.) yes no Growls at people outside of the family. Is shy. (If yes explain towards what.) yes no Is shy. Other problems not listed you would like worked on with your dog:What brand and type of food do you feed your dog? How much do you feed? Do you feed your dog at specific times or do you free feed? Where does your dog sleep at night? Is your dog on any medications? (If yes, please list:) yes no Is your dog on any medications?Is there anything else I should know about your dog?How did you find out about me?Additional Info or Comments:I affirm and attest that the above information is true and correct and based upon my personal knowledge and belief. Salty Dog Behavior Training reserves the right to refuse service to anyone.Date MM slash DD slash YYYY Signature Salty Dog Behavior Training LLC Agreement of Release and Waiver of Liability I (We) hereby agree to the following: I understand that my dog must be physically fit and has no medical condition which would prevent its full participation in any Salty Dog Behavior Training activity. I agree to bring my dog free of fleas and parasites and must be free of any infectious diseases before beginning any training. I agree to bring proof that my dog is current on the minimum of rabies and bordetella vaccines. I understand that attendance of a Salty Dog Behavior Training session or socialization class is not without risk to myself, members of my family or guests who may attend, or my dog, because some of the dogs which I (we) will be exposed to may be difficult to control and may be the cause of injury even when handled with the utmost care. I agree to comply with the instructions, rules and decisions of the training instructor as it relates to me or my dog’s ability to safely complete any training. I also agree to assume all responsibility for any damage done to property, persons, or other dogs done by me or my dog’s actions. I understand that dogs are individuals and Salty Dog Behavior Training does not make guarantees on the results. Your involvement and follow-through with the training is very important on helping make the best progress possible for your individual dog. I grant permission to Salty Dog Behavior Training to use my pet’s photograph(s) and/or video(s) taken during training sessions for educational and promotional purposes in any type of media. I hereby waive and release Salty Dog Behavior Training (including its employees, owners and agents) from any and all liability of any nature or damage which I or my dog may suffer, including specifically, but not without limitation, any injury or damage resulting from action of any dog, and assume risk of any such damage or injury while attending any training session held by Salty Dog Behavior Training. Name* First Last Date* MM slash DD slash YYYY Signature
