Behavior Questionnaire

Full Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Do you receive texts to this number?

Yes No

E-mail

What is the best way to contact you?

Phone call Email Text Facebook Messenger

Physical Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

How did you hear about me? *

Dog's Name *

Breed or mix *

Where did you get your dog? Please include name of rescue, shelter or breeder if applicable. *

Dog's age: *

How old was your dog when you got him/her? *

Is your dog spayed or neutered? *

Yes No Not Yet

Dog's sex: *

Male Female

Dog's weight *

Do you use a crate with this dog? *

Yes No We have one but do not use it. We use a pen indoors

Has your dog ever bitten a person or other animal? *

Yes No

If yes, please explain:

Is your dog motivated by food/treats? *

Yes Sometimes/Depends on the food/treat No

List your dog/puppy's favorite treats:

What equipment do you walk your dog with? *

Regular/buckle collar Martingale collar Prong/pinch collar Choke chain Harness- Regular or No-Pull

Has your dog ever worn an electronic/shock collar? *

Yes No Yes, Invisible/Wireless Fence System Unknown

Is your dog motivated by toys? *

Yes Sometimes/Depends on the toy No

List your dog/puppy's favorite toys & games: *

How often is your dog exercised? *

What kinds of exercise does your dog get? *

List any medications your dog is currently on and why:

Does your dog have allergies?

What brand/s of dog food do you feed your dog? *

How many times a day is your dog fed? *

Veterinarian (Vet's name & clinic name): *

Date of last vet visit and why: *

Has your dog had previous training? If yes, please list where and name of trainer: *

List any skills your dog knows well (sit, down, stay, etc) *

Please list IN ORDER OF IMPORTANCE what you would like your dog to learn: *

Please list any other pets in the home (name, breed, age):

Who lives in the home fulltime? Include ages of children, if applicable. *

How much time does your dog spend home alone? *

Where does your dog stay when home alone? *

Where does your dog sleep at night? *

Is there anything else you would like me to know about you or your dog/puppy?

Day Training programs include 3 lessons per week. What days of the week are best to schedule training visits?:

What days/time frames would be best to schedule the initial consult?

Which Day Training Program are you interested in?

Foundations Program (6 lessons) $540 Manners Program (10 lessons) $900 Head Start Program (15 lessons) $1350 Ultimate Program (25 lessons) $2250

I understand the Day Training program fee is due at the consultation (Manners and above may be split into two payments):

I agree

I understand that dog training and behavior modification is not without risk to myself, members of my family, guests, or my dog or other pets. I hereby waive my rights to any claim and release Jessica Hudson from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but not limited to, any injury or damage resulting from the action of any dog, and I expressly assume the risk of any such damage or injury while attending any training session, function or event wherever the activity is taking place. In consideration of and as inducement towards the acceptance of my enrollment in lessons, I hereby agree to indemnify and hold Jessica Hudson from any and all claims, or claims by me, any member of my family or any other person accompanying me to any training session wherever they may be located arising out of any action by any dog, including my own, including but not limited to the responsibility for all damages, expenses and legal fees. I further indemnify and agree to hold harmless Jessica Hudson from any and all claims, or claims by any third party at any training session wherever they may be located arising out of any action by any dog, including my own, including but not limited to the responsibility for damages, expenses and legal fees. I have read and, by completing this form and clicking submit below, agree to abide by the aforementioned Waiver and Assumption of Risk and Agreement to Hold Harmless.

Ultimate Puppy and Ultimate Dog Programs are prepaid in full unless otherwise agreed upon by both parties and non-refundable. If scheduled lessons are cancelled with fewer than 24 hours notice, that lesson is forfeited unless due to valid emergency. Any returned checks are subject to a $35 bank fee and a $20 late fee. Cash, Cash App, and checks are accepted.

Day Training Puppy/Dog Program Form

ABOUT YOUR DOG:

Additional Information