Your First and Last Name

Address

Email Address

Phone Number

Message

Emergency Contact

Acknowledgement Acknowledgement I acknowledge that the success of My Loyal Companion training programs at home are dependent on the Owners ability to maintain the rules, structure, and boundaries learned during the training program for a minimum of 3 months and/or when needed.

New Rules to Include: New Rules to Include: No Free Roaming. Crate. Daily Place duration. Daily Down Stay duration. or Actively working with Owner. Crate: EVERY night or when unsupervised. Thresholds. Every Door. Every Time. Exercise Regime: Daily Structured Walks Play: Only Controlled Play. No Free Toys. Rewards and Corrections. Use Appropriate and Consistent Feedback.

Veterinary Clinic

Veterinary Address

Veterinary Phone Number

Vaccination Dates or Titer Testing Results:

Bordetella Vaccination Date:

Flea and Tick Regime:

Veterinary Acknowledgement Veterinary Acknowledgement I acknowledge that My Loyal Companion requires veterinary documentation for all appropriate vaccinations (Bordetella, distemper, parvovirus and rabies) and/or Titer Testing results, and receipt of Flea and Tick Regime.

Dog's Name

Breed

Age

Sex

Spayed or Neutered: Spayed or Neutered: Spayed Neutered

Past and Current Medical Conditions

Breeder/Rescue/Other

Diet Type

Amount per Feeding

Feeding Times

Allergies or Intolerances

Food Acknowledgement Food Acknowledgement I acknowledge that My Loyal Companion does not provide food for meal times. The owner is responsible for providing enough food for their companion’s full stay at My Loyal Companion. This reduces stomach sensitivities and any potential issues.

Please describe your dog's daily routine

What motivates your dog? (food or toy)

Please Select All Behavioral Issues that Apply: Please Select All Behavioral Issues that Apply: Pulling Lunging Bolting Biting Nipping & Mouthing Barking Growling Whining Jumping Counter-Surfing Begging Excitement Separation Anxiety Fearful Nervousness Aggression Destruction (chewing, digging, ect) Anxious Velcro Dog Mounting or Marking Prey Drive (chasing squirrels, birds, cats ect) Resource Guarding (food, toys, furniture, people) Inappropriate Urination and/or Defecation Bite History

Triggers or Reactivity (doorbell, leash, human, other dogs, ect.)

Past Training Experiences

Programs of Interest Programs of Interest Private Programs Board and Train Programs K9 to 5 Structured Day Camp Structured Boarding

Other Animals Acknowledgement Other Animals Acknowledgement I acknowledge that My Loyal Companion may have over dogs/animals kept on the same premises as your dog.

What Tools do you use to walk your dog? What Tools do you use to walk your dog? Flat Buckle Collar Martingale Prong Collar Choke Chain Harness Long Line Flexi Leash 6-ft Lead Slip Lead Halti or Gentle Leader E-Collar

Crate Usage and Experience

Muzzle Usage and Experience

Canine Enrichment Activities

Daily Exercise Regime

Vehicle Experiences

Vehicle Acknowledgement Vehicle Acknowledgement I acknowledge that My Loyal Companion has permission to use personal vehicles with your dog for training purposes and outings.

Who lives in your household?

How many dogs do you have in your household?

Any other animals in the household?

Where does your dog sleep at night?

Do you take your dog to a dog park?

How does your dog interact with other dogs?

Are you willing to implement boundaries, rules, and structure for your dog? Are you willing to implement boundaries, rules, and structure for your dog? I acknowledge that My Loyal Companion is Balanced Training and uses both positive and negative teaching methods using rewards and corrections to learn, teach, and change the dog's behaviour. I am aware of the tools used on my dog for the training program (slip lead, prong, e-collar, crate). Please review Supplies Required*

Social Agreement Social Agreement I acknowledge that My Loyal Companion has permissions for the use of pictures, videos, voice clips, training information of sessions with the dog and/or owner for social media purposes, posts and sharing.

Name

Email Address

Message