Civil Obedience Dog Training
465 Alton Rd.
Galloway, OH 43119 (614) 853-3967 CivilObedience1@aol.com
How you acquired your dog (circle one) Breeder Pet store Humane society/shelter Other
Have you ever taken an obedience class? YES NO With this dog? YES NO
Has your dog ever bitten anyone (yourself included)? YES NO Did it break the skin, cause bruising or require sutures? YES NO
Does your dog exhibit aggressive behavior around other dogs? (snarling, baring teeth, barking) YES NO Around men, women or children? YES NO
Do you have any physical or mental disabilities that would affect your learning? Please explain:
How you heard about Civil Obedience Dog Training (please be specific) ________________________
Emergency contact person who will NOT be attending class with you (name and phone number):
Name________________________________________ Phone number ___________________________
MAIL COMPLETED REGISTRATION FORM WITH CHECK OR MONEY ORDER MADE PAYABLE TO AMY FLANIGAN ($95 for Monday classes, $110 for Tuesday classes).
YOUR PLACE IN CLASS WILL BE HELD AS SOON AS REGISTRATION FORM
AND CHECK ARE RECEIVED.