Requested Trainer

First Name

Last Name

Weeks

1

2

3

4

Dog's Name

First Name

Last Name

DOB

MM

DD

YYYY

Date In

MM

DD

YYYY

Date Out

MM

DD

YYYY

Exit Lesson Time

Hour

Minute

Second

AM PM

Phone Number #1

(###)

###

####

Phone Number #2

(###)

###

####

Do you have other pets at home?

Yes

No

Pet #1

Dog

Cat

Other

Do you have kids at home?

Yes

No

Do you have kids that visit?

Yes

No

How often do you provide WALKS for your dog?

Daily

Couple of times per week

Once per week

Couple of times per month

Once per month

Couple of times per year

N/A

Do you have a treadmill at home?

Yes

No

Does your dog know how to run/walk on the treadmill?

Yes

No

Has your dog ever been to a Day Care?

Yes

No

Did your dog have any issues during group play?

Yes

No

If NO, Are you interested in your dog joining group play?

Yes

No

Has your dog ever caused injuries to another dog?

(If yes, this does not automatically make your dog ineligible for group play. Every dog is assessed independently.)

Yes

No