Reactive Class Intake Form
This is a form for us to better understand your dog and your goals for the class. This form also helps us to determine if the reactive class setting is the best setting for your dog to learn or if your dog would be better suited for one of our other services.

After you fill out the form, a trainer at our facility will review your information and someone will be in contact with you via your preferred communication method on whether or not the reactive class will be a good fit or not. If it is a good fit, you will be sent a registration form to reserve your spot in the class!

If you have questions at anytime during this process or afterwards, please contact us at get@apleasantdog.com
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Email *
What is your full name? *
What is the best phone number to contact? *
What is your home address? *
Do you have a preferred method of communication? *
Which class day are you looking to sign up for? 
What is your dog's name, breed, age, sex, intact? *
Any food sensitivities or health concerns? *
Is your dog on any medications? If so, please fill them out below.
What are your goals that you hope to get out of this class? *
What have we already tried to mitigate the behaviors?
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Have you done any formal training with your dog before? If so, what have you done so far? *

Will your dog take high value items in new or stressful situations (i.e. taking treats at vet office, seeing a dog on a walk or playing with favorite toy at a friend’s house?)

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Does your dog react to? *
Required
Please elaborate on any information from the above question here. 
Has your dog ever bitten another dog or human? (please also include any air snaps, nips, growling, lunging, or protective behavior here) *
If there is any other information, questions, or concerns, please include them here. 
IF YOU DO NOT INCLUDE INFORMATION ABOUT PRIOR NIPS OR BITES IN THIS FORM, AND YOU ARE SCHEDULED FOR A PRIVATE TRAINING SESSION AT OUR NON-AGGRESSION RATE, IT IS POSSIBLE THAT THERE MAY BE A $50 TO $100 UPCHARGE AT THE TIME OF YOUR SESSION TO COMPENSATE FOR THE INCREASED DIFFICULTY OF THE SESSION. YOU MAY HAVE TO RESCHEDULE YOUR SESSION WITH A HEAD FACULTY TRAINER. Thank you for understanding!
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Required
The information you have provided will be used during your consultation if you choose or are recommended to a private consult in the future. This information will helps us to develop a diagnosis and training/management plan. All information will be held in confidence but may be shared with your veterinarian and their team.
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Required
I understand that working with dogs may entail certain risks of personal injury to myself or my dog(s). I hereby acknowledge my voluntary and informed assumption of full responsibility and liability regarding any injuries that I or my dog may incur coincident to my participation with A Pleasant Dog. I hereby assume any and all risks associated therewith and expressly waive, release, discharge and hold harmless A Pleasant Dog, its members, agents, employees and assigns from and against any and all liability for loss, damage, injury, illness or claim of any nature whatsoever, however caused, arising out of, in association with, or related in any way to my involvement with its services.
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