To schedule your FREE no obligation in-home dog evaluation please fill out the form below and Lisa will be right with you. FREE In-Home Dog Consultation Appointment Request Have you trained with us before? Yes No This dog A different dog Personal InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What county do you live in?* Phone*Email* Describe where you live*This helps us get a better all around picture of your dog’s environment.Individual homeApartment/CondoOtherDo you have a fenced in back yard?YesNoDog InformationBreed Dog's Name Birthday/Gottcha Day Current age of dog* Age when purchased or adopted* Tell us about your dog*Tell us all about your dog. What do they do that you like, what do they do that you don’t like, what do you want them to do? Too much information is better than too little.Have you used a dog trainer before? If so explain the outcome Does your dog get walked?*Whether yes or no please explain When walking your dog, do you use –*Flat CollarChoker CollarProng/Pinch CollarSlip CollarHarnessOtherCrate use*We don't use oneDog is fed in the crateDog sleeps in the crateDog is put in crate when we are awayCrate is used for punishmentHas your dog ever bitten a person or another dog?*YesNoIf you answered yes to the above question please explainIt happens, do your best to explain the circumstances. If you answered yes, please make sure that prior to answering the door for us you have a Baskerville Muzzle on your dog. We will take it off as soon as it is appropriate. This keeps us and the dog safe.Do you, or have you had to muzzle your dog?YesNoIs your dog up to date on their shots?* Vets name* Preferred day of the week for your appointmentMondayTuesdayWednesdayThursdayFriday (last appointment is 4 PM)Preferred time12 PM2PM4 PMHow did you find out about us?* What made you choose us?We know there are a lot of dog trainers out there, we are interested to know what made our clients choose us? Notes Waiver of liability*Animals are unpredictable and exposure/working with them is inherently dangerous, this can possibly result in serious, permanent, physical injury up to and including death on the part of the animal and humans involved. Although we take every precaution possible, we feel that you need to understand this. By checking this box you agree that you understand this, and you also agree not to hold liable MCS Dog Training, Modern Combative Systems LLC, or any of it’s owners, personnel, or volunteers, or independent contractors responsible for any injury or loss that results from its staff, dogs, any other unforeseen circumstance that may arise by the participation of myself, my family, and my dogs in training. Check the box below to acknowledge this and at the time of training you will be required to sign to affirm that you have read, understand, and accept the above. Signature of client and date __________________________________________________ Signature of trainer and date __________________________________________________ Check here if you read and understand the waiverCommunicating with usWe are only two people; Lisa runs the office and George trains the dogs. If you submit your appointment and don’t hear anything within 12 hours (excluding weekends) call Lisa at 717-693-2085. Once Lisa gets a submission, she will e-mail you the offer of an appointment based on the day and time your requested. We do our best to communicate by e-mail so that nothing gets lost in translation. We are old and forget stuff. Share this:FacebookX