Please provide the following contact information:

First Name
Last Name
Home Phone
Cell Phone
Work Phone
E-mail
E-mail 2

What is your dog's Name?

Please select the class you are interested in:

Private In-Home CE-1.0 CE-2.0 CE-1.0/Accelerated CE-2.0/Accelerated

What is your dog's breed?

What is your dog's gender?

Male Female

Medical Hist. / Vaccination Received & Dates:

We like to thank those who refer our services to new clients. To help us, would you share how you were referred?

Veterinarian Existing Client Internet Phone Book Other

Name of Veterinarian or client who referred you:

Do you have any knowledge of your dog acting in an aggressive manner towards other animals and/or humans? If Yes, please explain:

Media Release: Occasionally photographs are taken during the training classes and used in various print, internet or other media material promoting Collin County Canine.  Please indicate your consent to publish photographs.

I do consent. I do not consent.

Please list any toys that your dog has played with:

Describe your dog's feeding schedule and brand/type of food:

Are there any other pets in the home?

Estimate the amount of time you have to work with your dog:

List 2 unwanted canine behaviors you need help resolving:

What are your expectations for your dog after the training sessions?