Diamonds in the Ruff  	                   PLEASE MAIL THIS FORM WITH YOUR CHECK & VET SLIP!!
Training for Dogs & Their People


                      REGISTRATION FORM / STUDENT PROFILE

Your Name: ___________________________________________________   Phone:  (_____)___________(H) 

Address: _____________________________________________________      (_____)________________(W)

City ____________________ State _____  Zip ___________ Email ___________________________

I (we) attest that this dog is current on vaccinations and is examined regularly by  licensed veterinarian, and have reviewed our dog’s vaccination records with  Dr._________________________ at the ________________________ vet clinic who has deemed our dog’s level of immunity sufficient to attend a group class.   I (we) personally assume all responsibility or liability for this dog and agree to hold harmless DIAMONDS IN THE RUFF, its instructors, contractors, or employees, from any claim for loss or injury to person or thing due to negligence or any reason while in or upon the class premises or grounds or near any entrance to those grounds or premises.  I understand that the instruction I (we) will be given is based upon commonly accepted training techniques and I (we) personally accept responsibility for the application and use of those techniques as I (we) practice with and train this dog in class, in public, and in our home.

Signature:______________________________________________________ Date: ____________________
		( guardian must sign if student is under 21 years of age)


Tell us a little bit about your family:

Family members: # of adults _____  # of children _____ ages: _______________________________

What is your occupation/business? __________________________________________________________

Other pets:____________________________________________ 

Any problems?_______________________________________

Any physical limitations/health concerns? (Handler or dog) __________________________________

How did you hear about -or who referred you to- Diamonds in the Ruff? _______________________

How many dogs have you owned in the past? ___________ What breeds?___________________________

Have you attended an obedience class before? ________ When/where? ___________________________

What did you like / dislike about that class? _______________________________________________

What do you hope to accomplish in this class? _______________________________________________

Do you have any long-range goals for this dog? (i.e. showing, etc.) _________________________


Tell us about your dog:

Dog’s name _________________________________ Breed ___________________________Age __________

Male____ Neutered?____   /   Female____ Spayed?____  

Veterinarian/clinic name ______________________________________

Where did you get your dog?  Breeder, shelter, pet store, newspaper ad, other ______________ 
At what age?______________
                                        
                                    

Tell us about your dog’s home life: (be specific)

Approximately what percentage of time does your dog spend:  Inside ______ %  Outside _____ %  Without humans _____ %

Does your dog have a fenced exercise area? __________ 

Do you provide additional exercise?_______________________

Where does your dog sleep? ________________________________________________________________

What is your dog’s diet?_____________________ 

How often/where does your dog  eat?____________________

Person most responsible for feeding, cleaning up after dog __________________________________

How is dog confined during owner absence? ___________________________________________________

List your dog's favorite games / activities / toys / person _________________________________

List your dog’s least favorite games / activities / toys / person ___________________________

Your dog’s behavior:

What would you most like to change about your dog’s behavior? _______________________________

Any problems concerning your dog’s behavior around children, other pets, visitors, etc.? 

Explain ______________________________________________

Has your dog ever bitten anyone?______________ Explain: _____________________________________

Do you have any problems handling or grooming your dog? _____________________________________

What do you like best about your dog? _______________________________________________________


                              PERSONALITY PROFILE
         Circle ONLY ONE LETTER  per pair of words:   A or B or C or D

A= true in all situations  B= true in most situations   
C= true in most situations   D = true in all situations

Example: My Dog Is...  
	A= VERY outgoing  B= FAIRLY outgoing  C= FAIRLY clingy  D= VERY clingy
                                       
	outgoing	A   B    C   D	   clingy     
	demanding	A   B    C   D	   giving         
	independent	A   B    C   D	   dependent     
	leads 		A   B    C   D	   follows
	excitable	A   B    C   D	   calm        
	dominant	A   B    C   D	   submissive 
	controlling	A   B    C   D	   controllable 
	frustrating	A   B    C   D	   satisfying    
	intense		A   B    C   D	   mild     
	bold		A   B    C   D	   nervous 
	self-assured	A   B    C   D	   anxious       
	willful		A   B    C   D	   compliant
	assertive	A   B    C   D	   passive   
	stubborn	A   B    C   D	   willing-to-please
  voice insensitive     A   B    C   D     voice sensitive    
  touch insensitive	A   B    C   D     touch sensitive     
 												

Total: number of A’s _______ number of B’s _______ number of C’s _______  number of D’s ______