Private Lesson Intake Form Please fill out all required fields for form to properly submit. To check if form has submitted, click "Fill out intake form" button again. "*" indicates required fields Name* Preferred Pronouns Please list the other humans in the home and ages of children in the home.*Please list the other types of animals in the home and their ages.*Type of home*Apartment, Condo, House with/without fenced yard, etc. Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Best time/day for Private Lessons Dog's Name* Dog's Age* Dog's Breed* Dog's Sex*MaleFemaleDog's Weight* Dog's Color* How did you hear about us?* Is your dog neutered/spayed?*YesNoWhat vet do you currently use?* Is your dog up to date on vaccinations?*YesNoUpload a copy of vaccination records now? (Or email by lesson)*YesNo, email laterPlease upload a copy of your vaccination records*Max. file size: 256 MB.Please list any health conditions your dog has that you are aware of.* Please list any medications your dog is on. Be sure to include monthly preventative medications (heartworm and flea) as well as any as needed medications (for anxiety or car sickness) and supplements.* Are you considering rehoming your dog for behavioral reasons?* Which program are you interested in?*New Pet (Match Making) ProgramCooperative Care ProgramEssential Manners ProgramBasic Puppy ProgramNot sure. Would like to discuss with a trainer.Is there a specific package you're interested in?*Initial ConsultBronze Package (3 Lessons)Silver Package (5 Lessons)Gold Package (7 Lessons)Not sure. Would like to discuss with a trainerWhat brand of food does your dog currently eat?* Describe your dog's feeding ritual.*What type of treats do you currently use when training your dog?* Do you crate your dog? If so, when?* How long is your dog left alone each day?* What type of equipment have you used with your dog for leash walking? (Flexi/retractable leash, front/back clipping harness, head halter, choke chain, prong collar, etc)* What cues does your pet already know?*Have you ever used a shock collar?* Are you considering using a shock collar? (This includes an invisible fence.)* How do you currently discipline your dog?*How do you currently reward your dog?*Have you ever used a clicker to train a dog?* Was your dog rescued or purchased from a breeder? Please describe the details of either situation. Age rescued? How long have you had the dog?*How does your dog react to other dogs on leash?*Has your dog ever growled at another dog? If so, what were the circumstances?*Has your dog ever growled at a person? If so, what were the circumstances?*Has your dog ever bitten another animal? If so, please explain.*Has your dog ever bitten a person? If so, please explain.*List things your dog is afraid of:*List things that your dog is aggressive towards:*Have you and your dog ever participated in dog training with another company? If so were they private lessons or group classes? Where were they and what was the topic covered?*What are your immediate goals for training?*What are your long term goals for training?*I understand that all sales are final. Please initial.* I understand that all packages will expire four months after the purchase date. Please initial.* I understand that additional travel fees may apply depending on where I live. Please initial.* I understand that in the event of severe weather or other emergency the lesson may be postponed to the following week at the trainers discretion. Please initial.* I understand that children under the age of 12 must be accompanied by a non-participating adult. Please initial.* I understand that dogs must be up to date for their age on vaccinations in order to attend and will require proof of vaccinations. Please initial.* I accept all liability if any humans, animals, or property are harmed during the training process. Please initial.* I understand that if I fail to give 24 hours notice to cancel my lesson, I will be charged a $50 no show fee. Please initial.* I agree to have my dog photographed or videoed and shared on the website or social media. I agree to have me and my dog photographed or videoed and shared on the website or social media.