Canine Training Institute - Weekday Classes -

Please select one: *

Weekday Classes – Mornings
Weekday Classes – Afternoons
Weekday Classes – Evenings

I would prefer: *

Group Classes
Individual Sessions
No Preference

Dog Owner First and Last Name *

Name(s) of Additional Family Members Attending Training Sessions (spouse, children, etc.)

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Best Way to Contact Me? *

Email
Text
Phone Call

Dog's Name *

Dog Breed *

Dog Gender *

Dog Birth Date and Age *

Where Did You Obtain This Dog? *

How Long Have You Had This Dog (months, years)? *

Name/Clinic of Veterinarian *

Date of Last Veterinary Exam *

Please list all medications including heartworm preventative which your dog is currently taking *

Please list any health issues or food allergies your dog currently has *

What are you hoping to gain from this class? *

Basic Manners
Socialization
Other

If other, please list

List problems/issues you hope to solve, any important information about your pup, and what you hope to accomplish *

Have you ever done any type of training with this dog before? *

If yes, please tell us about the training

What type of dog socialization has your dog been exposed to? How does it react when it meets or sees another dog? *

How does your dog behave when it meets a person it hasn't met before? *

Describe how your dog acts while on a leash *

How best describes your dog's personality? *

If other, please describe

Dog handling, training & other activities can have risks for you, your family & your dog. By typing my name below, I hereby acknowledge I have voluntarily applied for canine owner/handling training conducted by the Humane Society of South Central Michigan (HSSCM). I fully understand that such training may pose risks to myself, my family & my dog. I freeling and knowingly assume these risks. I will not hold HSSCM, its members, officers, agents and employees legally or financially responsible for any injury to myself, my family or my dog. I understand that I am responsible for my dog and its actions and understand Act 73 of 1939 287.351. *

My dog is up to date, or will be brought up to date on core vaccines including rabies prior to the start of classes. *

Please attach proof of current rabies and other vaccines. We will need proof of current vaccines prior to the first class session.

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