Course & Start Date * Puppy Course - 12th March 2010 Obedience Course - 12th Mar 2010 Agility Course - 10th Mar 2010

Title * Mr Mrs Miss Ms

Name *

Address *

Daytime Telephone

Evening Telephone *

Email *

Age if under 18

Dog's Pet Name *

Kennel Club Name

Breed *

Dog's Age / D.o.B *

Sex * Dog Bitch

Neutered? * Yes No

Age when neutered

Age when obtained *

From Where? * Breeder Rescue Home Bred Other

Have you owned a dog before? * Yes No

What Breed?

Have you attended training
classes before? * Yes No

 If yes, where and when:

Where?

When?

State briefly the reasons
that brought you to class *

What do you hope to
accomplish? *

Do you have any hearing or
other physical handicaps? * Yes No

If so, what?

Does your dog have any
physical problems or disabilities,
which may affect their training? * Yes No

If so, what?

Has your dog attended a Vet for
any illness in the last 6 months? * Yes No

If so, please state the
nature of the problem

Veterinary Surgeon *

Date of last booster *

What kind of food do you
feed your dog?
Please state exact brand,
canned, dry, also extras,
milk cereals treats etc