VKBK Training Academy Dog Training Questionnaire
Please remember that answering truthfully each and every question is the only way to keep us safe and to help your dog. We are here to make your relationship better but we need to know where the miscommunication is first!!! Please provide as much detail and answer everything as honestly as possible, there are no dogs we turn away!
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Email *
Owner's Information *
First and last name
Address *
Email *
Phone number *
Texting Ok? *
Required
Dog's Name *
Breed *
Gender *
How long have you owned this dog? *
Where did you get this dog? (please list name of shelter, breeder, etc.) *
Please list any other members of the household (adults, kids -include ages, pets) *
Is your dog aggressive towards people? If yes, has your dog ever bitten? Please describe any incidents. *
Is your dog aggressive toward small animals? (cats, chickens, etc?) *
Is your dog reactive and/or fearful of other things (bikes, vacuum, noises, etc.)? Please describe. *
Does your dog pull on the leash or have any problems while walking? *
How often do you walk your dog? *
Check any equipment you use to walk your dog?
Does your dog jump/climb fences? If yes, what type *
Do you have a fenced yard for your dog? *
If you don't have a fenced yard, how do you take your dog outside (check all that apply): *
Required
What type of exercise does your dog get on a regular basis (at least one time per week or more)? Check all that apply. *
Required
Please list how your dog rides in a car: *
Does your dog ride well in a car? If no, or sometimes, please explain what the problems are. *
Which most closely describes how your dog eats? *
Does your dog bark a lot? If so, list what he/she barks at (or situations in which they bark) and anything you've done to try to prevent it. *
Does your dog jump on company and/or furniture? Are your okay with this or is it something you prefer they not do? *
Does your dog chew or destroy any human items in the house or yard? If so, please describe and also include anything you've done to try to prevent/correct it *
What kind of toys does your dog have? How many? Do they like to play with toys? What, if any, chewies do you offer them (rawhides, bones, etc.)? *
Is your dog housebroken? *
If you answered no or partly, what methods have you used? Have your methods been successful? *
When and how often does your dog have accidents in the house? Are they in front of you or hidden? *
Where does your dog stay while you are gone? *
Is your dog loud or destructive while you are gone? If yes, please describe in detail: *
Where does your dog spend most of its time when you are home? *
Where does your dog sleep at night? *
What, if any, formal training have you done with your dog? *
Was this with another trainer or by yourself? *
How many classes/sessions did you do?
How much follow through did you do? *
If you worked with a professional trainer who did you work with and what did you like or not like?
What commands does your dog know? Please check all that apply: *
Required
Are there occasions where your dog won't respond to one or more of these commands? What are those? *
What commands would you like your dog to learn? *
What other issues do you have with your dog? *
What is your favorite thing about your dog? *
Is there anything else you would like the trainer to know about your dog? *
GENERAL “HOLD HARMLESS” AGREEMENT & “LIABILITY RELEASE”                                  for Jennifer Gambino, CPDT-KA  (vom Kugelblitz Kennels and Training Academy/VKBK Training Academy)RESPONSIBILITY & LIABILITY:I feel confident that Jennifer Gambino, CPDT makes every effort to provide a safe environment for all canine and human clients under her instruction as well as others within the general proximity of her work.  I agree to place and/or leave my dog with Jennifer Gambino, CPDT at MY OWN RISK.  I have researched the skills and credentials of Jennifer Gambino, CPDT and AGREE with all associated handling practices, policies and procedures.  I understand that all dogs CAN and DO BITE; and I am aware of (1) the RISK of injury to myself or my dog(s) while in training and(2) that I am responsible for any INJURY, or physical or financial damages caused by my pet(s) to another pet, person or the physical location in which training is conducted.  I will NOT hold Jennifer Gambino, CPDT or her designated agents/associates, outside of gross negligence, responsible should an ACCIDENT, INJURY, ILLNESS, ESCAPE, THEFT, FIRE, or DEATH of my pet occur while in their care.  (3)  all the aforementioned specifically including 21 Game Farm Rd, Catskill NY as the main site location for training classes.MEDICAL TREATMENT:In my absence, I give permission to Jennifer Gambino, CPDT to act on my behalf in case of EMERGENCY or apparent health related issues.  I also give permission for my pet to be transported by car to (1) my personal veterinarian, (2) Jennifer Gambino’s vet of choice, or (3) Emergency Animal Clinic for any situation that medical assistance is needed while my pet is in the care of Jennifer Gambino, CPDT.  I agree to reimburse Jennifer Gambino, CPDT for any and all charges incurred for medical treatment of my pet.  I WILL NOT seek retribution from Jennifer Gambino, CPDT should an ACCIDENT, INJURY, ILLNESS, ESCAPE, THEFT, FIRE, or DEATH of my pet occur during or following ANY services rendered by Jennifer Gambino, CPDT or her designated agents or associates.VACCINATIONS/OVERALL HEALTH:I hereby declare that my pet is current within the calendar year on (1) Rabies, (2) DHPP, vaccinations.  I understand that it is my responsibility to keep my pets regularly vaccinated and to provide updated records to Jennifer Gambino, CPDT upon request and that my dog can be refused for services should I fail to do so.  I also understand that my dog is still susceptible to other illnesses due to age, stress, nutrition levels, immune system, and exposure to other dogs.  I understand that Jennifer Gambino, CPDT requires all dogs in training to be clean, healthy and vaccinated with no apparent fleas, ticks, worms, etc.MISCELLANEOUS DETAILS:(1) I understand that Jennifer Gambino, CPDT is not responsible for misplaced, lost, damaged or broken items during or following ANY services rendered.(2) I understand the rates and payment terms for services rendered by Jennifer Gambino, CPDT.(3) I understand that if I am not satisfied with the services provided by Jennifer Gambino, CPDT, that I will notify Jennifer Gambino, CPDT by close of business the following day.(4) I understand that Jennifer Gambino, CPDT has the right to refuse service to any owner and or pet at her discretion.(5) I understand that Jennifer Gambino, CPDT will NOT release my pet to anyone without my consent.RIGHTS TO PHOTOGRAPHS & VIDEO FOOTAGEI authorize Jennifer Gambino, CPDT the right and permission to use any photographs/video taken of my dog for any purpose and in any media now or in the future.I CERTIFY THAT I HAVE READ AND UNDERSTAND ALL OF THE CONDITIONS AND STATEMENTS CONTAINED WITHIN THIS AGREEMENT. *
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