Civil Obedience Dog Training

465 Alton Rd.

Galloway, OH 43119     (614) 853-3967    CivilObedience1@aol.com

 

CLASS STARTING DATE AND TIME: ______________________________

 

First/last names of all persons attending class                            

 

Address

 

City/State/Zip                                                                                      Home phone

 

Email address

 

Place of employment                                                                           Work phone

 

Name of dog                                                                                          Date of birth

 

Breed AND Weight                                                                            Spayed/neutered?           Male    Female

 

How you acquired your dog (circle one)        Breeder     Pet store     Humane society/shelter     Other

 

Goals you hope to achieve through this class:

 

 

 

 

Problem behaviors that need to be addressed:

 

 

 

 

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.