Your Information
Name * First Last
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number * - ### - ### ####
Email
About Your Pet
Name First Last
Breed
Weight
Age in Months
Age in Years
Birthday
Is your dog good with other dogs?
Has your dog ever bitten anyone?
Has your dog ever attacked or bitten another animal?
How often is your dog around other animals?
Is your dog licensed in the County in which you reside?
Is your dog spayed or neutered?
Does your schedule allow you to work with your dog 30 minutes per day?
How did you hear about Lucky Puppy?
I would like assistance with the following “problem” behaviors with my dog:
Jumping Housebreaking Unruly House Behavior Excessive Barking Door Crashing Digging Puppy Nipping & Mouthing Inappropriate Chewing Counter Surfing
Other problem behaviors I would like to see addressed, if time allows:
Which scheduled class would you like to like to attend?
Please include the date and time of the class you would like to attend *