Betty's TLC Dog Training - Registration Form 2012
PRINT THIS FORM. Fill out this form in its entirety.
Your e-mail must be legible to receive your e-mail confirmation for your course and future notices on all courses and dog sport programs - please print
legibly!!
Fill in all information, mail form with check or money order to: Betty’s TLC Dog Training, 126 Beacon Street, Middletown, RI 02842. Enclose fee of $175.00 in
check or money order payable to “Betty’s TLC Dog Training”. Once your registration is received, you will receive a confirmation via regular mail.
THIS REGISTRATION FORM MUST GO THROUGH THE REGULAR MAIL – DO NOT E-MAIL THIS FORM!! PAYMENT IN FULL MUST ACCOMPANY THIS
REGISTRATION FORM at least 2 weeks prior to your scheduled course!
(All courses are located and conducted at the Middletown High School in the rear field on the side of the school building– outdoors) Rain dates are made up
for free.
1. Your payment must be received at least 2 weeks prior to the start date of your course.
2. Your dog must be up to date on all vaccines including rabies, copy of vaccinations and rabies must accompany this registration.
3. Do not enroll your adopted dog unless you have owned him/her for at least one month prior to enrolling.
First Name:
Last Name:
Address:
City:
State:
Zip:
Phone:
Cell:
E-mail:
Dog's Name:
Age:
Breed:
Sex: Altered Male: Altered Female: Intact Female
Intact Male Age when acquired: Color of dog:
Dog's physical limitations:
Dog's medical problems (if any, please list):
Dog's Behavioral problems: (list all problems that you would like to address - feel free to use back of sheet):
Where did you acquire this dog (be specific):
Previous training?
Where? (be specific)
Instructors name and certification/s:
Did you finish the training course:
If not, why?:
What type of training has your dog had? Circle all that apply:
Positive only positive and negative - e-collar - no training at all- trained dog myself
Other: (explain other)
How is your dog confined when outdoors? Highlight all that apply:
Invisible fence - structural fence (cannot see through) chain link - picket fence - stockade (cannot see through) tied out to
fixed structure - other (explain):
Has your dog ever bitten, snapped or growled? (explain each and every incident in detail):
Is your dog aggressive with other dogs?
Has your dog ever been attacked by another dog?
If yes, how many times?
Was your dog on a leash when he/she was attacked?
If no, explain each and every incident:
Do you crate your dog during the day?
How many hours a day is your dog crated at a time?
How many hours a day is your dog home alone?
Do you take your dog to doggie daycare, if so name of facility?
How many other animals does your dog live with?
What are they?
Do they coexist together or do you separate them?
List family members that coexist with this dog- ages, sexes:
In your opinion, what types of people and animals does your dog seem to not get along with?
How many homes has this dog had prior to yours:
Does this dog have any compulsive disorders, if so, explain the compulsive disorders:
What is your veterinarian's name:
Name of your veterinarian's practice:
Veterinarian's phone number (in case of emergency):
If your dog was adopted from a shelter, please give the name and address of the shelter and the date of adoption:
If known, what geographic location was this dog purchased/adopted from:
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I am enrolling/registering for the dog training course that begins on _______/_______/______ @ ________am/pm
I have enclosed a fee of: $__________to reserve my space in this course.
............................................
Sign and Date!!!
Waiver/release - (Read and Sign) - No admittance without this waiver!
I understand that I must be fully responsible for my dog's behavior while on the school grounds and/or in surrounding areas of
the school. I agree to hold Betty's TLC Dog Training and the school completely harmless in the event that either myself or my dog
causes pain or injury to another individual, dog or the property while in participation at this course. I agree to be completely
liable for any/all damages or injuries while in attendance with my canine. I do understand that participation in any dog training
course will not guarantee a risk free, non aggressive canine. I also release and agree to hold harmless – Betty’s TLC Dog Training
LLC - in it’s entirety while in participation at any/all training and/or specialty courses that I decide to participate in. In the event
that another participant or dog injures me or my canine, I will hold Betty’s TLC Dog Training LLC and the property in which the
injury occurred, completely harmless. I state that I am in good physical condition at the time of my enrollment into these
courses. I agree to take full responsibility for my actions, health and decisions during any/all lessons/session/events conducted by
Betty’s TLC Dog Training LLC. Furthermore I am stating that I am not under the influence of any alcoholic beverages and/or
mind altering drugs while in participation of any of these events that I am enrolling into.
Signature of handler/owner:_____________________________________Date____________
Print name:_________________________________________Date:_________________
Please make a copy of this waiver for your records!
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Middletown High School Dog Training Rules - Please cut on dotted line and keep this portion:
1. All dogs must come to class on a regular flat buckle collar or harness and 6’ training lead (may be purchased at any pet store.
Retractable leashes are NOT allowed in my classes.
2. All dog waste must be immediately picked up by the owner and disposed of in the receptacle on the field.
3. Dogs must stay on leash at all times while on the school grounds unless otherwise instructed by Betty’s TLC
4. Boots or sneakers only – no flip flops or sandals!
5. Dress warmly!
6. Bring enough high value treats to last you an hour in class
7. All treats must be hidden away from the dog (please purchase a bait bag or put treats in your pockets)
8. Please be respectful of other students and be on time.
9. Class begins at 6 pm and ends promptly at 7 pm.
10. There are absolutely no dogs allowed on the Middletown High School Property at any time other than your 1 hour
lesson/class. Dog owners will be cited and fined for trespassing on school grounds at all other times.
11. Drive carefully through the parking lot since other school activities may be taking place.
12. Children may come and observe as long as they can sit in a chair for an hour, quietly. We cannot have children on the field
when training is in session. They MUST be able to sit quietly for an HOUR.
13. Bathroom your dog before coming to class.
14. Do not feed your dog before class! We want hungry dogs to work for treats in class. If your dog has had an evening meal
chances are that he will not be hungry for treats
15. You may bring water and a bowl for your dog.
Extra equipment that you will need for class:
Motivational toys that your dog loves, i.e.; tennis balls, squeak toy, tug toy, etc.
Long line – 30-50’
Whistle – may be purchased at any store
Clicker – optional
Betty's TLC Dog Training LLC and the Middletown High School are NOT liable for any lost property.
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