1. Handlers Name: 
Phone #
2. Dog's Name: Email Address:
3. Breed(s):
4. Age: Height: Weight: Sex:
5. Has the dog been spayed or neutered?
6. Are you the primary owner of the dog? If not, what is your relationship to this dog?
7. How long have you owned the dog?
8. Where did you obtain the dog?
9. When was the dog last Vaccinated?
10. Is the dog on any medication? What and Why?
11. Has the dog ever bitten anyone?
If so, please describe when this happened and the circumstances:
12. Has the dog ever been in a fight with another dog?
If so, please describe how many times this has happened and the circumstances:
13. Check the specific program(s) that you are interested in enrolling:
14. List your expectations from this class:
