CZ Dog Training - 2009/2010 Course Registration Form

All dogs and pups must be parasite free and have proof of vaccinations appropriate for age and Bordetella (Kennel Cough). Please mail or bring a copy of vaccinations to first class.

For class, unless otherwise instructed, please bring your puppy/dog wearing a regular 6 – 7 ft leash. Also bring a baggie / treat pouch full of 2 types of small yummy soft treats - bits of cut (not shredded) meat and cheese work fine too.

If you cannot open the file, please copy the registration form below. The form transfers well if you set the new document's right and left margins at .55 each. Thank you and our apology for any inconvenience.

Name __________________________________ Email _____________________________

Home phone # _____________Work phone # ______________ Cell# _________________

Street Address ______________________________________________________________

City, State, Zip _____________________________________________________________

Occupation(s) ______________________________________________________________

Do you have a hearing problem or other physical limitations?_________________________

Dog’s name _______________________ Breed ____________________ Age ______ M / F

Vet ________________________ Health Problems_________________________________

Medications/Supplements________________________    Neutered  yes / no

Age dog obtained_____From________________History_____________________________

Is your dog outdoors, indoors or both?     Sleeps in or out      Left alone daily for _____hours

Daily play w/ you_________w/ dogs_________ Time spent on walks_____________________

Diet/food ____________Amount per day_______ free fed or scheduled mealtimes at ________

Current Training _____________________________________________________________

Type of collar and reward(s) used for training _______________________________________

List specific problems you are having _____________________________________________

__________________________________________________________________________

How do you deal with these problems? ___________________________________________

__________________________________________________________________________

Dog’s reaction?______________________________________________________________

What are your goals and expectations for your dog and this class?_______________________

__________________________________________________________________________

Prior training and classes ______________________________________________________

__________________________________________________________________________

Name of the course you are requesting__________________________________________

Start date__________________ Location ___________________________ Time__________

Amount of check______________ Referred by _____________________________________

Please complete this form. Return it with a check made out to Cerena Zutis
and mail it to 1773 Lake St., San Mateo, 94403 Thank you!