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ABOUT YOURSELF
Items with '
*
' must be completed
Name
*
:
Street
*
:
City
*
:
State
*
:
Zip
*
:
Telephone(H)
*
:
Telephone(W):
E-Mail Address:
ABOUT YOUR DOG
Your Dog's Name
*
:
Breed
*
:
All-American
Other: (type in)
Age
*
:
1 month
2 months
3 months
4 months
5 months
6 months
7 months
8 months
9 months
10 months
11 months
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
Gender
*
:
Male
Female
Who referred you to our classes?
What do you want most to accomplish?
What problems, if any, are you having?
CLASSES
*
(select at least one class)
No classes are available for signing up at this time.
Please tell us what class you are interested in,
and we will get back to you.
QUESTIONAIRE
Does your dog...
Yes
No
1.
...bark at loud noises?
2.
...bark at strangers?
3.
...chase a ball, frisbee or other toys?
4.
...chases cars or people?
5.
...follow you around house or yard off leash?
6.
...greet you happily when you return home?
7.
...get into the trash or counter surfs?
8.
...sit quietly while in the car?
9.
...play nicely with other dogs?
10.
...accept treats from a stranger?
11.
...growl, bark, or snap at other dogs?
12.
...growl, bark, or snap at a person?
RELEASE OF LIABILITY
*
*
I have read and fully understand Golden Rule Dog Training's Release of Liability Agreement.
Click
here
to read the Class Registration Agreement and Release of Liability (opens new window).
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