Client Registration

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

First NameLast Name
Occupation*
Phone Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

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

MaleFemale
Fixed*

YesNo
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*

Day Train 2 weeksDay Train 4 weeksDay Train 6 weeksBoard and Train 2 weeksBoard and Train 4 weeksBoard and Train 6 weeksPackage of Private sessions- (Location- Stateline Canine)Behavior Modification 4 weeksBehavior Modification 6 weeks
Behavior Problems (check all that apply)

jumps upnuisance barkingnipschewseats foreign objectshowlspulls on leashdisobeysunrulyshyaggressiveruns away
Has your dog ever growled, snapped, or bitten you or anyone else?*

YesNo
If yes, please specify
Does your dog get nervous around strangers?*

YesNo
If yes, please specify
Has your dog ever shown aggression towards other dog?*

YesNo
If yes, please specify
Has your dog played with other dogs?*

YesNo
If yes, please specify. i.e. multiple dogs, one other dog, etc
Does your dog ever get mad at you or do anything spiteful?*

YesNo
If yes, please specify
Does your dog get upset when you leave him/her alone?*

YesNo
If yes, please specify
Do you ever confine your dog away from you while you are home and awake?*

NoYes, crateYes, room/areaYes, outside
Do you confine your dog when you leave?*

NoYes, crateYes, roomYes, outside fence or kennel run
Do you allow your dog off leash?*

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

AlwaysNeverOnly when there are no distractionsYes,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?*

NoSometimesAlways
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 onceNibble throughout the daySkip mealsRequire canned food (or something similar) to make it more palatable
Does your dog have any know health problems/concerns? allergies, displaysia, etc.*
Veterinary Address and Phone Number
We will post pictures and videos of your furry friend on Facebook and Instagram. We will post pictures and training videos on our Social Media platform, if you would like pictures sent to you please include a phone number or email address that you would like us to send them.
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