Guardian's Name:*

Home Phone:*

Alternate Phone:

Address:*

City:*

Province:*

Postal Code:*

Email Address:*

Dog's Name:*

Breed / Mix:*

Age {at time of class}:*

Sex (Male / Female): Please Select*

MALEFEMALE

Spayed / Neutered: Please Select*

YESNO

How long have you owned the dog?*

I make the following representations about my Dog: (check those that apply)

The undersigned is the only owner of Dog.
Dog is in good health.
Dog is friendly toward adults.
Dog is friendly toward children.
Dog is friendly toward other dogs and other animals.
Dog is not nursing puppies.
Dog has never started a fight with another dog or other animal.
Dog has never bitten a person.
Dog is not the subject of a quarantine order at this time.
Dog does not have to be muzzled around people.
Dog is not a guard dog or protection dog.
There is no pending adjudication or administrative hearing pertaining to Dog or Dog Owner.
Dog has never been declared a dangerous or potentially dangerous dog, or vicious or potentially vicious dog.

Vet's Office or Name:*

Vet's Phone:

Identifying Marks / Colourings / Tatoos:

Microchip ID #:

Does your dog have any physical limitations or medical concerns?

YESNO

Please Explain:

How did you hear about CANINE SOS Inc.?*

Have you ever attended an obedience class before with this dog?*

YESNO

Where / When:*

What concerns you most about your relationship with your dog?

Check anything that applies to your dog:

MOUTHY
SHY
PUSHY
GROWLS
NOISY
FEARFUL
DESTRUCTIVE
EXCESSIVE ENERGY
GUARDS FOOD
GUARDS TOYS
WON'T LISTEN TO ME
TOO ATTACHED TO ME
OTHER

Briefly explain anything you have checked off: