Out of State (not TX) Request for Training

Have you trained with us before?

Yes
No
This dog
A different dog

Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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.

Do you have a fenced in back yard?

Dog Information

Breed

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 –*

Crate use*

Has your dog ever bitten a person or another dog?*

If you answered yes to the above question please explain

It 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?

Is your dog up to date on their shots?*

Vets name*

Preferred day of the week for your appointment

Preferred time

How 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 waiver

Communicating with us

We 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.

Out of State Request For Training

Personal Information

Dog Information

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