KG CANE CORSO INTAKE FORM

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This form has been created to get to know you and your furry friend. Please complete this form as much as possible. Submitting a partially filled form will delay your processing time.

Email *

Owner First and Last Name: *

Co-Owner First and Last Name:

Address: *

City: *

State: *

Zip: *

Primary Contact #: *

Secondary Contact#:

Requested Start Date: *

YYYY

Referred By:

Canine Profile

Canine's Name: *

Age: (YEARS) & (MONTHS) *

Sex: *

Male

Female

Breed:

Veterinarian Name: *

Veterinarian Address: *

Medical Problems: *

Medications: *

Time/Dosage:

Allergies:

Last Vaccinations: *

YYYY

Dog Food Brand:

# Daily Feedings: *

Feeding Time(s)

Amount:

% Time Spent Indoors:

% Time Spent Outdoors:

% In Crate:

Potty Trained:

Yes

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Schedule:

Has canine ever bitten or injured another animal or human being? (Y/N) *

Yes

If yes, please explain below:

Additional Information:

Enrolling Training Class *

Basic Obedience Training - On Leash

Advanced Obedience Training - Off Leash

Behavior Modification Training

Potty Training

Required

Protection Training (Prerequisite Required: Advanced Obedience)

Protection Level 1

Protection Level 2

Protection Level 3

Training Expectations

Additional Notes:

Applicant understands there will be a non-refundable evaluation fee to give an estimate on the cost of training (evaluation fee will be applied to the training cost and will be scheduled after submission of intake form) *

Yes

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