Client Registration

581 West Chestnut St, Hanover, PA 17331 717-632-1111
Owner's Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Phone Number

Area Code Phone Number
E-mail *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

How did you hear about us? *
Dog's Name *
Date of Birth *
closest guess if unknown
Breed and Weight/Size *
Sex *

Male Female
Fixed *

Yes No
Where did you get your dog? *
How much did you pay? *
How old was your dog when you obtained him/her? *
Physical Description (color/markings) *
Training Course *

Leave-N-Learn (day training) PRIME 2 weeks Leave-N-Learn PREMIUM 4 weeks Leave-N-Learn ELITE 6 weeks Lodge-N-Learn (in board training) PRIME 2 weeks Lodge-N-Learn PREMIUM 4 weeks Lodge-N-Learn ELITE 6 weeks Package of Private sessions- In Home Package of Private sessions- Stateline Canine
Behavior Problems (check all that apply)

jumps up nuisance barking nips chews eats foreign objects howls pulls on leash disobeys unruly shy aggressive runs away
Has your dog ever growled, snapped, or bitten you or anyone else? *

Yes No
If yes, please specify
Does your dog get nervous around strangers? *

Yes No
If yes, please specify
Has your dog ever shown aggression towards other dog? *

Yes No
If yes, please specify
Has your dog played with other dogs? *

Yes No
If yes, please specify. i.e. multiple dogs, one other dog, etc
Does your dog ever get mad at you or do anything spiteful? *

Yes No
If yes, please specify
Does your dog get upset when you leave him/her alone? *

Yes No
If yes, please specify
Do you ever confine your dog away from you while you are home and awake? *

No Yes, crate Yes, room/area Yes, outside
Do you confine your dog when you leave? *

No Yes, crate Yes, room Yes, outside fence or kennel run
Do you allow your dog off leash? *

No Yes, fenced yard Yes, yard with no fence Yes, other fenced areas (such as a dog park) Yes, areas with no fence (park, beach, etc)
Do they come when called? *

Always Never Only when there are no distractions Yes,unless there are heavy distractions
How do you discipline your dog when they disobey/misbehave? Does it work? *
Does your dog live in the house? If not, where/why? *
Is your dog allowed on furniture? *
Is your dog allowed to sleep in your bed? *

No Sometimes Always
Does your dog show aggression or fight you when you move them off of furniture, groom or crate them? *
How much AEROBIC exercise does your dog receive on a regular basis? What kind? *
What kind of food does your dog eat? (brand) *
How much food does your dog eat? (standard 8 oz measuring cup)
Do they... *

Eat it all at once Nibble throughout the day Skip meals Require canned food (or something similar) to make it more palatable
Does your dog have any know health problems/concerns? allergies, displaysia, etc. *
additional info
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