NEW STUDENT APPLICATION
PARENT INFORMATION
First Name:
Last Name:
Spouse/Partner Name:
Cell Phone:
Alternate Phone:
Email:
Alternate Email:
Address:
City:
State:
Zip:
How did you hear about us:
Please Select
A Little Pet Inn
Referral
Internet Search
Other
When are you generally available for training/consultation? (Check all that apply)
Please Select
Weekday afternoons (12PM - 4PM
Weekday evenings (7PM - 9PM)
Weekend mornings (9AM - 12PM)
Weekend afternoons (12PM - 4PM)
What is your dominant learning style?
Demonstration
Listening
Reading
Doing
Is this your first dog?
Yes
No
On a scale of 1 to 10, how frustrated are you with your dog"s current behavior?
Please Select
1
2
3
4
5
6
7
8
9
10
Are you able and willing to make changes to your daily routine to develop better communication with your dog?
Yes
No
How much time per day can you devote to training your dog?
Please Select
15 minute
30 minutes
45 minutes
60 minutes
More than 1 hour
List the ages of the members of your household:
What attributes do you love about your dog?
What attributes do you dislike about your dog?
What would you like to improve regarding your relationship with your dog?
What are your goals for you and your dog?
Obedience
Behavior modification
Tricks
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DOG INFORMATION
Pet Name:
Breed:
Date of Birth (or best estimate) mm/dd/yy
Weight:
Sex:
Please Select
Male
Female
Spayed/Neutered
Yes
No
Where did you get your dog?
When did you get him/her?
How old was he/she when you adopted/bought/rescued?
If adopted or rescued, what do you know of your dog"s history and previous home life?
Why did you choose him/her? (ex. coloring, cutest, quietest, boldest, most playful, most relaxed, etc.)
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Upload Current Vet Records
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Veterinarian Name:
Veterinarian Phone Number:
If not spayed/neutered, will they be? Please comment :
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DOG EATING HABITS
What brand and type of food does your dog eat (wet, dry, or both):
How often to you feed your dog per day? (Check all that apply)
Morning
Mid Day
Evening
Free Fed
Does your dog eat table scraps?
Please Select
Yes
No
Does your dog eat treats?
Please Select
Yes
No
What are your dog"s favorite treats?
ENVIRONMENTAL ROUTINE
Where does your dog spend his or her time when no one is home?
Where does your dog sleep at night?
On average, how long is your dog home alone every day?
Is your dog crate trained?
Please Select
Yes
No
Is your dog house broken?
Please Select
Yes, always goes outside
No, still training
Uses potty pads indoors
Has some accidents
Describe your dog"s daily walks and exercise routine (times, who walks, duration, where, frequency):
What type leash do you use?
Please Select
Fixed
Retractable
Chain Link
None
What type of collar when walking?
Please Select
choke
flat
front clip harness
head halter
regular harness
What are your dog"s favorite activities, toys, and games?
Has your dog had any previous formal training?
Please Select
Yes
No
Where?
PetSmart
Private Trainer
Barkbusters
Other
If other, please describe:
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ENVIRONMENTAL TRIGGERS
Please indicate any trigger that produces anxiety, fear, or aggression in your dog:
Thunder
Fireworks
Hats
Loud noises
Wheels (skateboards, bicycles, etc)
Other
If other, please describe:
What is your dog"s reaction?
Indicate any methods you have tried to modify your dog"s behavior:
Avoiding the trigger
Head halter
Herbal Supplements
Prescription Medications
Increased exercise
Environmental enrichment
Ignore dog
Give dog "time out"
Yell "no"
Treats
Shock Collar
Does your dog follow any of the following commands?
Sit
Stay
Leave it
Down
Fetch
Heel
Tricks
Watch Me
Come
Drop It
Other
Does your dog work well for:
treats
food
toys
attention
Does your dog exhibit any of the following behaviors?
Act irritated by or resentful of petting
Demand to be petted
Bark excessively
Cower or hide when people are loud or act boisterously
Enjoy meeting strangers in your house
Enjoy meeting strangers away from your house
Enjoy meeting other dogs while on leash
Enjoy meeting other dogs while off leash
Does your dog display an adverse response to any of the following:
Touching food or bowl while dog is eating
Taking away bone, toy, or treats
Waking dog or disturbing its rest
Restraining dog when it wants to go
Lifting dog
Petting dog
Medicating dog
Reaching for collar
Staring at dog
Reprimanding dog
Removing dog from furniture
Describe the response:
My dog becomes anxious, fearful, or aggressive when I:
Rows
Never
Rarely
Occasionally
Frequently
Always
Prepare to leave the house
Pick up my car keys
Put on my coat or shoes
While I"m away, my dog:
Rows
Never
Rarely
Occasionally
Frequently
Always
Loses his appetite
Destroys my property
Urinates and/or defecates indoors
Has diarrhea
Vomits
Licks excessively
Barks or whines excessively
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LIABILITY WAIVER
I understand that submitting this application is considered acknowledgment of the following: I understand that dog training is not without risk to me, my dog, members of my family, or guests who might attend my training session. Therefore, I release Wagging Willow LLC, its employees, volunteers, officers, and agents from any and all liability of any nature, for injury or damage that I or my dog may experience during training sessions while on the training grounds, host property and surrounding property or, in the case of private training, in my home. I understand that all dogs are different and they progress at different rates. I understand that Wagging Willow LLC will do their best to help me reach the training goals listed for each level of training, however, results are not guaranteed and it is ultimately my responsibility to continue training at home or my dog may revert back to previous behaviors. Wagging Willow, LLC may use pictures of me or my dog for publicity or promotional purposes of Wagging Willow LLC without liability or obligation of any kind to me.
*
I ACCEPT
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