Common Active Dog Injuries Seminar

Date

Name*

Cell Phone*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Email*

Where did you hear about Agility Underground?*

What type of training are you interested in?*

What is your availability?

Monday

AM
PM

Tuesday

AM
PM

Wednesday

AM
PM

Thursday

AM
PM

Friday

AM
PM

Saturday

AM
PM

Please describe your dog’s previous training taken with us or elsewhere (If Any)

Do you crate your dog?

Yes
No

Do you have a separate room or place for your dog?

Yes
No

Do you tie your dog outside?

Yes
No

Do you have an outside kennel / run for your dog?

Yes
No

Where does your dog sleep at night

Yes
No

If on a couch or bed, will your dog vacate the spot at your request?

Yes
No

Is your dog spayed/neutered?

Yes
No

Are your dog’s vaccinations up to date?

Yes
No

Are there other dogs in the home?

Yes
No

If so, list:

Can your dog be safely left alone in your house?

Yes
No

Can your dog be safely left alone in your car?

Yes
No

Are there situations when your dog appears stressed?

Yes
No

If so, describe:

Have you taken your dog to any training classes?

Yes
No

If so, describe type of class and with whom:

Does your dog easily comply with a request to give up anything in his/her possession?

Yes
No

If given a treat, does your dog take it gently?

Yes
No

Can your dog be petted, moved, or interrupted while eating?

Yes
No

Can all family members expect reasonable compliance to reasonable requests?

Yes
No

Is there a family member that your dog disregards or ignores?

Yes
No

so, who?

When guests arrive is your dog out of control?

Yes
No

What does your dog do?

When at the vet’s office will your dog allow itself to be restrained and/or examined without struggling, growling, or biting?

Yes
No

When you encounter other dogs is your dog out of control?

Yes
No

What does your dog do?

What are the situations that cause your dog to growl?What actions do you take?

Has your dog ever bitten a person?

Yes
No

If yes, how many times:

Describe the bite:

Just cause a bruise?

Break the skin?

Stitches needed?

Has your dog been in a dogfight with another dog?

Yes
No

Check all that apply:

Neither dog got hurt
My dog had a few cuts
My dog had at least one puncture wound
My dog needed stitches
The other dog had a few cuts
The other dog had at least one puncture wound
The other dog needed stitches

Are there situations in which you feel you have little or no control over your dog?

Yes
No

If so, describe:

Has your dog ever been on a choke, pinch, or shock collar?

Yes
No

If yes, how long?

Is your dog contained by any electronic fencing system?

Yes
No

If yes, how long?

Is food left out continually for your dog?

Yes
No

Last visit with a vet?

Name of vet:

Any health problems?

Yes
No

If so, describe:

Any medications?

Yes
No

If so, list:

What do you feed your dog? How much per day?

What are your goals for your dog?

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

My dog has problems with:

My dog has problems with: Men with (hats, beards, sunglasses, other: (Define))

My dog has problems with: Kids (Ages: (Define))

My dog has problems with: Grooming (Define):

My dog has problems with the following inanimate objects:

My dog has problems with other dogs when they: