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© Pet Dog Training, 2001

Please complete this online form.
Then continue to Step 2 in the registration process and choose a payment option.

IMPORTANT: You can secure a space in a class only when your check or money order has been received in our office or when your PayPal credit card payment has been verified.

Mailing address: PetDog, 13 Finch Lane, Gloucester, MA, 01930

IMPORTANT: Please review FREQUENTLY ASKED QUESTIONS before the first class.

Owner

Your Name:
E-Mail:
Home Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
Work Phone:
Others Attending Class:
(e.g. names of children, spouse, etc.)
Pet  
Name:
Breed:
Sex:
Male
Female
Neutered/Spayed ?
Yes  
No If "No", do you plan To?
  Yes No
Birthday:
Age Today:
Date Adopted:
Referred By  
 
Vet
Breeder
Friend
Yellow Pages
Other
Name:
Liability Waiver  
I hereby for myself, my heirs, executors and administrators waive and release Glenn E. Goldman, Judith Goldman, and any officers, employees, agents, volunteers and supervisors working with/for Glenn E. Goldman or Judith Goldman and/or the organization at whose facility I and my dog are training from any and all liability of any nature for injury or damage which I or my dog, or any member of my family or anyone accompanying me may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any training session or any other function or while on the training grounds of the surrounding area thereto. In consideration of and as inducement to the acceptance of my application for training with Glenn E. Goldman and Judith Goldman, I hereby agree to indemnify and hold harmless Glenn E. Goldman, Judith Goldman, et al from any and all claims or claims by any member of any family or any other person accompanying me to any training session or function of Glenn E. Goldman, Judith Goldman, et al or while on the grounds of the training facility or the surrounding area thereto as a result of any action by any dog, including mine.
Do you accept these terms?
Yes
No
Questionnaire  
Is this your first dog?
Yes
No
Why did you choose this particular dog?
Are you happy with your choice?
Yes
No
Why?
Previous training school:
What did you learn that worked well?
What hasn't worked?
Present Problems (check all that apply):
Housebreaking Coming when called
Pulling on Lead Nipping
Biting Chewing
Jumping up Barking
Shyness Fearfulness
  Aggression with:
Other dogs
People
Children
Certain People
   
Has your dog had previous owners?
Yes
No
Do you feel that your dog may have been abused?
Yes
No

If yes, why?
If you could "reprogram" your dog, how would he/she act?
Is there anything else that you would like to tell us?