CivilObedience1@aol.com
Phone: (614)
853-3967

Get control using gentle, effective methods that both you and your dog will love.

REGISTER ONLINE

Fill out and submit this form for class registration:

CLASS STARTING DATE AND TIME:
First & Last Names of ALL Persons Attending Class:
Full Address (including City/State/Zip):
Home Phone:
Email Address:
Place of Employment:
Work Phone:
Name of Dog:
Date of Birth:
Breed AND Weight:
Spayed/Neutered?		Yes No
What sex is your dog ?		Male Female
How you acquired your dog: (choose one):
Breeder Pet Store Humane Society/Shelter Other (please explain)
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
If YES to above: 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):
Comments?
Emergency Contact Person: (Name AND Phone Number of Someone NOT attending class):
Name:
Phone Number:

YOUR PLACE IN CLASS WILL BE HELD AS SOON AS REGISTRATION FORM AND PAYMENT ARE RECEIVED.