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How did you hear about Canine Coaching?
Vet Internet Tear Sheet Friend Shelter/Rescue Yellow Pages Cable Other

OWNER'S INFORMATION
Last Name		First Name
Street Address		City
		State
		Zip Code
Phone Number
E-mail Address

PET'S INFORMATION
Pet's Name		Age	Years Months
Breed		Color
Sex	Male Female
Neutered/Spayed	Yes No	If yes, at what age?
My dog's reaction to strangers is: Very Friendly Reserved Fearful May bite
My dog was: purchased from breeder pet store At age adopted at age

PROGRAM INFORMATION
What program would you like more information about?

Private Lessons			Any Age
Puppy Kindergarten Classes			8 Weeks to 4 ½ Months
Group Basic Obedience Classes			Over 4 ½ Months
Intermediate and Advanced Obedience Classes			Over 4 ½ Months
Therapy Dog Training			1 Year by End of Program
Behavior Problem Consultations			Any Age
Preparing Your Dog for a New Baby			Any Age
Board and Train			Any Age
Additional Comments:

We look forward to working with you. Feel free to contact us at 845-634-4344 or contact us by clicking here - Contact Us