Certified Animal Trainer
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PLEASE DO NOT FILL OUT UNLESS YOU HAVE AN APPOINTMENT ALREADY CONFIRMED.
Owner's Name *
Postal Code *
Dog's name *
Dog's breed *
Dog's sex *
How long have you had this dog? *
Where did you get the dog? *
Have you had dogs before? *
Does your dog have any allergies? *
If so, please list:
Is your dog on any medications? *
If so, please list with what they are being treated for:
Who will be the primary trainer? *
Who else lives in the house? *
Are there other animals in the house? *
Does your dog have a bite history? *
If so, who does he/she bite?
Was doctor/vet consulted?
Was by-law consulted?
Level 1. Obnoxious or aggressive behavior but no skin-contact by teeth.
Level 2. Skin-contact by teeth but no skin-puncture. However, may be skin nicks (less than one tenth of an inch deep) and slight bleeding caused by forward or lateral movement of teeth against skin, but no vertical punctures.
Level 3. One to four punctures from a single bite with no puncture deeper than half the length of the dog’s canine teeth. Maybe lacerations in a single direction, caused by victim pulling hand away, owner pulling dog away, or gravity (little dog jumps, bites and drops to floor).
Level 4. One to four punctures from a single bite with at least one puncture deeper than half the length of the dog’s canine teeth. May also have deep bruising around the wound (dog held on for N seconds and bore down) or lacerations in both directions (dog held on and shook its head from side to side).
Level 5. Multiple-bite incident with at least two Level 4 bites or multiple-attack incident with at least one Level 4 bite in each.
Level 6. Victim dead.
Has the dog had previous training classes? If so with whom? *
What behaviours does the dog know?
How does the dog react to strange humans? *
How does your dog react to strangers coming to the home?
Where is the dog kept when you are not home? *
Is the dog crate trained?
Does your dog pull when walking? *
What type of collar and leash does the dog wear when walking?
Have you tried other leashes/collars?
What type of exercise does the dog get? How often? *
How long is the dog left alone in a typical day? *
Does the dog respond to their name when called? *
What are the top three things you would like to change about your dog’s behaviour? *
Are you considering rehoming your dog for any of these behaviors? *
How did you hear about me?
I understand that all dogs are different, and they progress at different rates. I understand that Cindy Peacock will make every attempt to help me train my dog to the best of her ability. I understand that I must continue training my dog at home or my dog may revert back to previous behaviors. I understand that by training with Cindy Peacock that I may be putting myself, my family, my dog and/or any guests who may also attend in a situation not without risk. Some of the dogs I/we may be exposed to could be hard to handle and could cause injury even when handled with the utmost care. I hereby waive and release Cindy Peacock, their agents and employees from any and all liability for injury or damage to my dog or myself that may be incurred while attending training sessions. I will assume all risk of any injury or damage resulting from the actions of any dog including my own.
* I have read and understand the above waiver.
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