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VKBK Training Academy Registration Form
Please fill out the following questions.
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Owners Information
Name
*
First and Last name
Your answer
Marital Status
*
Your answer
Is your dog licensed?
*
Yes
No
Are you a first time dog owner?
*
Yes
No
Do you have other animals in your house?
Yes
No
Other:
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Do you have children in your house?
Yes
No
Other:
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How do you identify?
Male
Female
Prefer not to say
Other:
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What is your address? (Street, city, state, zip)
Your answer
What is your home phone number?
Your answer
What is your cell phone number?
Your answer
What is your occupation?
Your answer
Who is your employer?
Your answer
Who were you referred to us by?
Online
Trainer
Family
Close to home/work
Yellow Pages
Other:
What do you wish to accomplish with training your dog?
Your answer
Dog Information
Dog's name:
Your answer
Birth Date:
MM
/
DD
/
YYYY
Dogs breed:
Your answer
Dogs Sex:
Male
Female
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Have you owned this dog since it was a puppy?
Yes
No
Other:
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If not, what age did you acquire the dog?
Your answer
Is your dog spayed or neutered?
Yes
No
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Where did you get your dog?
Your answer
Has your dog ever bitten anyone?
Yes
No
Other:
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If your dog has bitten someone, who and where?
Your answer
What kind of training has your dog had?
Obedience
Behavioral
Agility
Self
Group
Private
None
Unsure
Previous owner did
Other:
Is your dog possessive of food?
Yes
No
Other:
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Is your dog possessive of toys?
Yes
No
Other:
Clear selection
Is your dog aggressive with strangers?
Yes
No
Other:
Clear selection
Is your dog leash aggressive?
Yes
No
Other:
Clear selection
Does your dog run away?
Yes
No
Other:
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Is your dog scared?
Yes
No
Other:
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Check all that apply. Is your dog....
House trained
Crate trained
Ok with other dogs
Ok with kids
Does your dog have any medical issues?
Your answer
Does your dog take any medicine?
Your answer
What type of food do you feed your dog?
Your answer
Is there anyone else who wants to participate in training?
Spouse
Child
Friend
Other:
Veterinarian Information
Veterinarian Office Name:
Your answer
Veterinarian name:
Your answer
Veterinarian Office phone number:
Your answer
Veterinarian Fax Number:
Your answer
Option 1
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The above information is true to the best of my knowledge. I authorize vom Kugelblitz Kennels Training Academy (VKBK TA) to contact my vet and verify my dog’s vaccination status or discuss any issues pertinent to my dog’s behavioral or obedience training.
Your name:
Your answer
Todays date:
MM
/
DD
/
YYYY
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