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SOUTHERN MARYLAND DOG TRAINING CLUB

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SOUTHERN MARYLAND DOG TRAINING CLUB Powered By Docstoc
					       SOUTHERN MARYLAND DOG TRAINING CLUB OF FORESTVILLE, INC.
                      CLASS ENROLLMENT FORM

    Puppy Course $60 ________ Basic Course $60 ________ Novice Course $75 ________

Owner Information
Owner’s Name _________________________________________________________________
Address ______________________________________________________________________
City/State/ZIP __________________________________________________________________
Home Phone ____________________ Work Phone ___________________________________
Email Address _________________________________________________________________
Dog Information
Dog’s Name _____________________ Breed ________________________________________
Date of Birth/Age _______________________________________________________________
Weight _______ Sex _______ Spayed/Neutered ______________________________________
Referred by ___________________________________________________________________

Where did you get your dog? ______________________________________________________
Is the dog house trained ____________________ Crate trained __________________________
Is your dog crated on a schedule for naps, rest periods, etc? _____________________________
How long is the dog left alone each day? ____________________________________________
Where is the dog when you’re not at home? __________________________________________
Where does the dog sleep at night? ________________________________________________
Is this your first dog? If not, please describe__________________________________________
_____________________________________________________________________________
Has this dog had prior training and if so, where/when? __________________________________
_____________________________________________________________________________
Has this dog ever bitten a person ________________Another dog ________________________
Describe circumstances of bite(s) __________________________________________________
_____________________________________________________________________________
What specific things are you hoping to learn in this class? _______________________________
_____________________________________________________________________________
Please circle any of the following problems that apply to your dog:
Chewing Going into trash Jumping on people Leash pulling Digging
Won’t come when called Barking Growling Mouthing (play biting)
Biting Other behaviors _________________________________________________________
Please circle any of the following that describe your dog’s temperament:
Friendly Easily distracted Hyperactive Mellow Stubborn Confident
Playful Affectionate Aggressive toward people ____ other dogs _____
Shy with men _____ women _____ kids _____ other dogs _____
Vaccination/shot record checked by ________________________________________________
Check attached? Yes ____ Amount _________ Balance due? ___________________________

Please read and sign (if under 18, a parent or guardian must sign)
I certify that I will hold harmless the Southern Maryland Dog Training Club of Forestville, Inc., and
all persons connected therewith in any capacity whatsoever, from any and all liability, cost, and
expense for any injury or damage to persons or property, caused by any dog brought by myself or
anyone to the training class and any and all events held or sponsored by this Club. I realize that
dog behavior can be somewhat unpredictable. SMDTC recommends that I obtain liability
insurance through a homeowner’s policy or tenant policy.


Signature                                                         Date



Make all checks/money orders payable to: SMDTC. Mail check and enrollment form to: Linda
Ciampo, 14901 Wannas Drive, Accokeek, MD 20607.

				
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