Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNumbers *Email *Adults in home *Children in home and ages *Emergency Contact Name *Emergency Contact Phone Number *Pet InfoName *Breed *Birthdate *Spayed or Neutered? *SpayedNeuteredUnalteredDate of last DHPP Vaccine or Core Vaccine and Type *Date of last Bordetella Vaccine *Date of Last Rabies Vaccine and Type (1 year or 3 year) *Date of last Heartworm Test and Result *Is your dog on Heartworm Prevention? If so, type *Does your dog have any medical issues? *Does your dog have any allergies? *Vet InfoName *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNumbers *Training and BehaviorHas your dog had professional training before? If so, with who and when *What training tools do you use? *MartingaleProng CollarChoke CollarHalterGentle LeaderElectronic Collar aka Shock CollarBark CollarClickerElectric FencePet CorrectorNoneHave you used any other training tools not listed? If so, what? *What training tools have you used? *MartingaleProng CollarChoke CollarHalterGentle LeaderElectronic Collar aka Shock CollarBark CollarClickerElectric FencePet CorrectorNoneWhat training tools will you not use? *MartingaleProng CollarChoke CollarHalterGentle LeaderElectronic Collar aka Shock CollarBark CollarClickerElectric FencePet CorrectorNoneWhat is your reason for looking for a trainer and what are your goals? *Has your dog ever shown any signs of aggression (toys, food, people, other animals...)? *What days are you available to train and what hours? *Please upload a picture of your pet *If you have Facebook and would like to be added to our private group training page, please provide your Facebook profile name hereName of person filling out this form *Todays Date *EmailSubmit