(267) 221-4915 ~ Changing the way you see your dog ~ Bucks County, Pa
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Please contact Sonia at 215-221 4915 for availability. Now offering a Buy One, Get the Second at Half Off - "Bring a Friend" group class deal. Enroll full price and your friend gets 50% OFF. Maximum capacity is 8 dogs. Classes held just north of Montgomeryville, Pa. A description of the class can be seen on www.misunderstoodcanines.com/classes.htm
Last Name : ________________________First Name____________________
Address: _______________________________________________________
City_____________________ Zip__________________
Phone Number:________________________
Email Address:________________________( IMPORTANT!)
Your Pet’s Info
Dog’s Name_______________________
Breed_________________________________ Age__________________Sex_____________
Is he/she spayed/neutered? ¨ Yes ¨ No When?______________________________
How long have you had your dog? ________________________________________________
Where did you get your dog?______________________________________
Has your dog ever bitten or attempted to bite any person or animal? ¨ Yes ¨ No
If so, did it involve any of the following? ( check all the apply)
¨ Other animals ¨ People ¨ Both
Please describe the situation briefly.( IMPORTANT!)
_____________________________________________________________________________
What is your knowledge level of dog obedience today?( Please check the appropriate box.)
¨ I am brand new to this.
¨ I attempted dog training classes before.
(When/Where were these classes?______________________)
¨ Have been doing ok, but need some more work.
What specific obedience or behavioral problems would you like help with? Explain.______________________________________________________________________
_____________________________________________________________________________
How well do you rank your knowledge of dog obedience? __________
(worst) 0 1 2 3 4 5 6 7 8 9 10 (best)
How well do you rank your dog’s responsiveness to your commands? ________
(worst) 0 1 2 3 4 5 6 7 8 9 10 (best)
Are you interested in participating in any of the following?
¨ AKC/UKC Obedience Competitions ¨ Therapy Dog Participation
¨ Canine Good Citizen Certification ¨ Basic Obedience & Household manners
Medical Info:
VeterinaryClinic_______________________________City__________________________ Date Rabies vaccine was given?____________ Due when?__________
Are there any current medical problems? Please explain briefly( example- allergies, seizures, diabetes):____________________________________________________________________
Waiver & Agreement
¨ I understand that dogs that choose to use aggression must have their environment and training managed and that the aggression may never go away. Training will include behavior modification and safety techniques to attempt to keep the family safe. I understand that it is always advised to consult with my veterinarian for any medical problems that may be causing the aggression.
¨ I understand that participation in dog owner/handler training, or related classes, may necessarily expose the participants to certain risks.
¨ I understand that this training is meant to act as a guide in your understanding of your dog so that you can be better prepared to handle your dog in “real life” situations. I also understand that there may be interaction with other dogs ( animals) and people during these sessions and that Sonia Dieter with Misunderstood Canines does not, and cannot, warrant the behavior or temperament of any dogs participating in such classes, or of the owners/handlers of such dogs. Sessions completed are guidance for the training of your dog. You also understand there are no guarantees in the complete and long term success of your dog’s behavior as a result of the training because owners must understand that each of individual family and their dog will have a different success rate depending on their execution of the training. It is required that the owners follow through with the training or recommendations in between classes and after our sessions have ended to enhance the long term success.
¨ Payments – Payments are final March 2, 2009. Cancellations must be sent via email to misunderstoodcanines@yahoo.com Checks that do no clear the bank will be subject to a $25 returned/insufficient funds fee.
Signature of Owner(s)
_________________
( over 18 years of age )
Forms returned via email are assumed to be signed.
Photography/Video Release
I hereby consent that the photographs/videos in which either my dog, my family members or myself appear may be used by Sonia Dieter DBA Misunderstood Canines and their assignees or successors, for the sole purpose of education or publicity in personally authored books, websites or advertisement publications without any financial compensation.. All attempts will be made to present these videos or photographs in a professional manner and in good taste. This consent is expressly intended to release from liability all personnel in participation with Sonia Dieter and Misunderstood Canines.
If I am a parent or guardian submitting this application, I give my permission for any photographs or videos of dog training activities which may include my child, to be used in promotional materials (including the world wide web) and brochures without any financial compensation.
Name: ______________________________________________________________
Signature: ____________________________________________________________
Address: _____________________________________________________________
City:_______________________________ State: ____________ Zip: __________
Phone: ______________________________________ Today's Date: ___/___/____
_________________________________________________
Signature of Parent or Guardian (if participant is a minor)