New Client Intake Form Step 1 of 4 25% Client InformationToday’s Date* MM slash DD slash YYYY Client's Name* First Last Occupation Co-Owner’s Name First Last Occupation Home/Cell Phone*Email* Address* Street Address Address Line 2 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 Children & Ages How/where did you hear of us? Have you moved with your dog within the last 12 months? Yes No Have you added or lost any pets within the last 12 months? Yes No Have you added or lost any family members within the last 12 months? Yes No Dog InformationDog's Name:* Date of Birth* MM slash DD slash YYYY Breed or Breed Mix* Weight* Sex:* Female Male Spay/Neuter* Yes No Where did you get your dog? How long have you had your dog? Why did you originally adopt your dog(s)? Medical HistoryList all medications your dog is currently taking: Vet Clinic: Vet’s Name: Vet's Address PhonePlease list any current or past medical issues including surgeries, infections, etc. Other PetsName Age Species/Breed Sex: Female Male Spay/Neuter Yes No Name Age Species/Breed Sex: Female Male Spay/Neuter Yes No About Your Dog’s LifestyleWhere is your dog when he is home alone? Where does your dog sleep at night? Does your dog have a crate? Yes No Does your dog like the crate? Yes No Where is the crate located? Does your dog chew or destroy the crate? Yes No How many hours does your dog spend alone each day? <1 hr 1-3 hrs 3-6 hrs 7-9 hrs 9+ hrs What kind/brand of food do you feed your dog? How much and how often does your dog eat? Is food left out during the day for your dog to eat? Yes No Dog’s allergies What kind of toys does your dog have daily access to? Nylabones Rawhides Stuffed animals Kongs Tennis balls Rope toys Frisbees Food-dispensing toys Hollow bones Bully Sticks Other Please list other toys How long does your dog play with toys? Where are the toys kept when not in use? How often does your dog go on a walk? Who walks your dog? How long is the walk? Does your dog have any other exercise activities? What does your dog wear on a walk? (Harness, No-Pull Harness, Prong/Choke Collar, Head Halter, etc.?) Do you ever walk your dog off leash? Yes No Do you take your dog to dog parks? Yes No Does your dog pull on walks? Yes No If your dog pulls, what have you tried to change his behavior? About Your Dog’s HistoryDoes your dog have a history of any of the following? (check all that apply)* Select All Biting other dogs or humans Separation anxiety Resource guarding or aggressive tendencies Reactivity such as lunging, barking, growling, or overreacting to dogs, people, or other stimuli None of the above Has your dog ever growled at a person or dog?* Yes No If yes, please describe what happenedHas your dog ever nipped/bitten a person or another animal before?* Yes No If yes, please describe what happenedIf your dog has nipped/bitten a person or animal, was there a tear, scratch, bruise, bleeding, or puncture?Check all that apply Tear Scratch Bruise Bleeding Puncture NOT requiring stitches Puncture requiring stitches Is your dog fearful or nervous about certain people/dogs/situations?* Yes No If yes, please describe what happensHow does your dog respond to new people in your home? How does your dog respond to grooming or bathing? What is your reaction when your dog ignores you? What trainers, boarding facilities, or pet services have you used for your dog in the past? (Name/City)Please list any of the following tools that you currently use or have previously used with your dog: Flat Collar Martingale Collar Choke Chain E-Collar Bark Collar Citronella Collar/Spray Spray Water Bottle Clicker Extendible (Flexi) Leash Waist Leash Front-Attach Harness Back-Attach Harness Double-Clip Harness Head Halter Other Please list other tools About Your Dog’s Training GoalsList 5 Things You Like About Your DogList 5 Things You Wish You Could Change About Your DogWhat made you reach out to us for training assistance?What would you like to accomplish through training?How would your ideal dog behave?Thank you for taking the time to fill out our registration form. These details will help us better serve you and your dog. We look forward to working with you! Please verify the information was entered by you. Thank you.I understand and agree to the policies at the bottom of this page.* Yes No Signature*By indicating my consent, I am signing this agreement electronically. I agree my electronic signature is the legal equivalent of my manual signature on this Agreement. If I am signing on behalf of another individual, I attest that I have the authority to do so.To submit your information, please hit send. If you do not receive confirmation the form has been sent, scroll up to make sure all required fields have been entered. Policies Paid pre-registration is required to reserve a space in class. There will be no refunds after class begins. Please make sure your dog’s vaccinations are up-to-date. Only healthy dogs may come to in-person classes and training. Owners should keep their dogs at home or reschedule private training in cases of sneezing, coughing, diarrhea or other potentially contagious symptoms. Owners are expected to maintain and reinforce training outside of the class setting. Children 8 and over are welcome at in-person group classes as long as they remain with their parents throughout class, and follow trainers’ instructions. At their discretion, instructors associated with Joyful Dog LLC have a right to refuse admission to or expel a dog/handler from class. Waiver I understand that attendance at a dog training class is not without risk to myself, my dog, members of my family or guests who may attend. I agree to release and hold Joyful Dog LLC, its instructors and teaching assistants, the training facility, and their respective officers, directors and employees harmless of any liability arising from this training activity and/or information or consultation provided by Joyful Dog LLC. I expressly assume the risk of damage or injury therefrom.
