Registration Form

Registration form for Private Instruction
(Please reach out and let us know your needs before filling out registration, if you have not already. We are only able to accept a limited number of new clients.)

Please note that if you have previously filled out paperwork, you do not need to do it again to sign up for additional services. Just send us an email.

Be sure to have a quick look at our coverage areas before you take the time to fill out registration.

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Where did you hear of us? *

Dog's Name *

Breed or mix *

Age *

Spayed/Neutered *

Gender *

Vet's Name *

Address/Phone if known *

Reason for last vet visit *

Does your dog have any allergies or medical problems? *

Does your dog take any medication, including flea/tick/heartworm preventative? *

How long have you had your dog? *

Where did you get your dog? *

Did your dog have other owners? *

Please list other pets in the household *

How many times a day does your dog go out? *

How many times a day does your dog eat? *

Has anything in the household changed since acquiring your dog? *

What exactly do you feed your dog? *

How large is your living space? (studio, house, 2 bedroom, etc) *

Describe how you leave from & return to your home (big hello & goodbye to the dog or no fuss) *

Who lives in the household? *

What does your dog do as you prepare to leave? *

Please list what your dog knows (sit, leave it, etc) *

What is your dog's training history, and at what age did you start? *

Are there any behavior problems you'd like to discuss? *

I grant my permission for Walk This Way Canine Behavior Therapy, to work with my pet in the area of Canine Behavior Therapy. I understand that in the area of Obedience Training, owner compliance is necessary for the dog to understand and retain the training he/she has received. I also understand that in the area of Behavioral Problems, owner compliance and patience are key in the rehabilitation of my pet. I understand that any behavioral abnormality is controllable but not necessarily curable, especially when concerning aggression problems. I do not hold Walk This Way Canine Behavior Therapy responsible for the actions of my animal during or after treatment. If my pet is left in the care of Walk This Way Canine Behavior Therapy and needs medical attention, I authorize Walk This Way to consult with my veterinarian. If my veterinarian is unavailable, I authorize Walk This Way Canine Behavior Therapy to utilize the services of another vet or emergency hospital. I understand that I am responsible for any charges in respect to veterinary care. Fees and deposits are non-refundable. Payment is expected at the time of service. If the trainer arrives and my dog is not home, the full amount will be charged. Appointments scheduled for 12noon-8pm on weekends or after 6pm on weekdays require a credit card deposit equal to the full amount of the appointment. Cancellations for those time slots made less than 48 hours in advance will incur a fee of 50%. By entering my name in the box below, I certify that this is a legal and binding signature. *

Date *

Submit