Behaviour Information Form

1. DOG DATA

*
*
*
*
*
*

2. CLIENT DATA

*
*
*
*
*
Please indicate consent for the CowK9 email list*
We send out an email "Newsflash" about once a month; you can unsubscribe at any time.)
How did you hear about Cowichan Canine?*
Please tick all that apply.

3. DOG'S BACKGROUND

From whom did you get this dog?*
*
If re-homed, what were the reasons given to you?
Please tick all that apply
*
*
Please indicate which of the following events that have occurred in your dog's life history:
Please tick all that apply.

4. HOUSEHOLD

*
Please also describe how each person gets along with the Dog (or not, as the case may be)
Please also describe how each pet gets along with the Dog (or not, as the case may be)

5. VETERINARY MEDICAL INFORMATION

*
*
*
Please submit your dog's latest vaccination/titer record for DAPPV to email info@cowichancanine.ca*
Valid vaccination/titer certificate is required before your dog can attend our training centre.
Does your dog have any allergies, including food allergies?*
Does your dog have any other medical issues?*
Please include all medications, including flea/tick medications.

6. DOG'S DIET

*
What feeding schedule do you use?*
Please tick all that apply.
*
*

7. DOG'S HOME LIFE

How much time does your dog spend home alone (=no humans at home)?*
Does your dog go to daycare?
*
If none, please indicate that.
*
*
*
*
*
If never restricted, please indicate that.
*
If never, please indicate that.
How does your dog tolerate being crated / confined?*
How often are there house-training accidents?*
How often does your dog normally defecate, and do the stools appear healthy?*
Please tick all that apply.
How often in a day does your dog go out for bathroom breaks?*
Please tick all that apply.

8. DOG'S SOCIAL LIFE

What types of collar, leash, harness, etc, do you use?*
Please tick all that apply.
How many walks does your dog get in an average day?*
How much time does your dog spend on walks, in total, on an average day?*
How much of this walk time is spent OFF leash?*
*
*
*
With how many different DOGS from outside the home does your dog socialize with in an average week?*
How many of these dogs are known friends of your dog?

9. DOG'S LEARNING HISTORY

PUPPY CLASS: Did your dog participate in puppy classes before 16 weeks of age?*
PUPPY CLASS: What training methods were used in puppy class?
Please tick all that apply.
CLASS 4-6 MO: Did your dog participate in training classes when he/she was between 4-6 months old?*
CLASS 4-6MO: What training methods were used in the 4-6 mo class?
CLASS 6-12MO: Did your dog participate in training classes when he/she was between 6-12 months old?*
CLASS 6-12MO: What training methods were used in the 6-12 mo class?
Please tick all that apply.
CLASSES 1YO+: Has your dog participated in training classes since he/she was 1 year old?*
CLASSES 1YO+: What training methods were used in the 1yo+ classes?
Please tick all that apply.
PRIVATE TRAINING: Have you taken private training/behaviour consultations with your dog at any time?*
PRIVATE TRAINING: What training methods were used in the private lessons?
Please tick all that apply.

10. DOG'S GENERAL TEMPERAMENT TRAITS

Which of the following statements apply to your dog?*
Please tick all that apply.

11. DOG'S RELATIONSHIPS WITH PEOPLE

Which of the following statements apply to your dog?*
Please tick all that apply.

12. DOG'S RELATIONSHIPS WITH OTHER DOGS

Which of the following statements apply to your dog?*
Please tick all that apply.

13. DOG'S TRAINING STATUS

Which of the following statements apply to your dog?*
Please tick all that apply.

14. DOG'S BITE HISTORY

Has your dog ever bitten a person or another dog?*
Please indicate the number of incidents. A "bite" also includes air-snaps.
Please indicate the number of incidents. A "bite" also includes air-snaps.
FIRST BITE: How many bites were inflicted on each victim?
FIRST BITE: How serious was the worst bite in this incident?
WORST BITE: How many bites were inflicted on each victim?
WORST BITE: How serious was the worst bite in this incident?
LATEST BITE: How many bites were inflicted on each victim?
LATEST BITE: How serious was the worst bite in this incident?

15. CONDITIONS OF SERVICE

Cowichan Canine agrees to provide evaluations, private lessons and/or consultations ("Consultations") for Client and Dog. These Consultations may take place at Cowichan Canine's facility, in Client's home and/or at other suitable venue as determined by mutual agreement, including via telephone or electronic medium. Services may be provided by Lisbeth Plant and/or any other designated representative of Cowichan Canine Behaviour & Training Ltd, as mutually agreed.*
Cowichan Canine will make every reasonable effort to help Client achieve training and behaviour modification goals, but cannot make any guarantees of Dog’s performance or behaviour as a result of providing these services.*
Client gives Cowichan Canine permission to discuss Dog's behaviour with Dog's veterinarian from time to time, when mutually agreed or when contacted by Dog's veterinarian. Cowichan Canine will never charge for communicating with Client’s veterinarian, but cannot guarantee that Dog's veterinarian will not charge Client for any such communications. Normally, such communications are commonly either a brief telephone conversation and/or an email which may have client's file attached..*
Client will give full disclosure of any circumstances surrounding Dog and his/her behaviour, and full and truthful answers to all questions relating thereto, written or verbal.*
Client needs to be committed to investing the time and effort necessary into working with Dog and to do all the homework and exercises to the best of their ability, including making every effort to ensure that members of the Client's household and other persons with whom the dog may come into contact are also following Cowichan Canine's instructions.*
Client understands that Client and members of the Client's household must follow Cowichan Canine’s instructions without modification, and work with Dog as instructed.*
Client will openly and honestly discuss with Cowichan Canine any problem, inability or unwillingness to follow any instructions, so that Cowichan Canine and Client can resolve these together and so that there are no misunderstandings that may interfere with Dog’s progress.*
Client understands that the advice that Cowichan Canine will give Client is based on current scientific knowledge of learning science and dog behaviour and is based on force-free and fear-free principles. Cowichan Canine will not use any techniques that are intended to cause Dog fear, pain or discomfort.*
If Dog causes property damage, or kills or bites or injures any other dog, animal or person during or after the term of this Agreement, or is injured or killed at any time during or after the term of this Agreement, then Client agrees to pay all resulting losses and damages suffered or incurred, and to defend and indemnify Cowichan Canine and/or Cowichan Canine’s agents from any resulting claims, demands, lawsuits, losses, costs or expenses, including lawyer and legal fees actually incurred by Cowichan Canine and/or Cowichan Canine’s agents, and agrees that Cowichan Canine and/or Cowichan Canine’s agents shall not be held responsible for any resulting injuries, losses, damages, costs or expenses whatsoever.*
Client will not make any claim, including a third party claim, and not to seek any claim or contribution, against Cowichan Canine Behaviour & Training Ltd, including its directors, agents, assigns, staff and instructors.*
Each time the Client meets with Cowichan Canine or any of Cowichan Canine's agents, he/she declares him/herself and all other persons accompanying the Client to be in compliance with Cowichan Canine’s from time to time published Health Declaration and Safety Plan regulations.*
Cowichan Canine's duties hereunder shall terminate if (a) in Cowichan Canine's sole judgment Dog or Client or any member of Client's household is dangerous or vicious to Cowichan Canine and/or Cowichan Canine’s agents or any other person or animal, or interferes with the training of other dogs, or (b) Client does not pay any service fees due, or (c) Client breaches any term or condition of this Agreement or (d) either party cancels this Agreement. Upon termination in accordance with the foregoing, Cowichan Canine's duties and responsibilities, and that of Cowichan Canine's agents, shall terminate but all other provisions of this Agreement shall continue in full force and effect in perpetuity.*
This Agreement is binding upon Client, and the members of the Client’s family and household. This Agreement supersedes all prior discussions, representations, warranties and agreements of the parties, and expresses the entire agreement between Client and Cowichan Canine and/or Cowichan Canine’s agents regarding the matters described herein. The parties confirm that, except for that which is specifically written in this Agreement, no promises, representations or oral understandings have been made with regard to Dog or anything else. Without limiting the generality of the foregoing, Client acknowledges that Cowichan Canine and/or Cowichan Canine’s agents have not represented, promised, guaranteed or warranted that Dog will never bite, that Dog will not be dangerous or vicious in the future, that Dog will not exhibit the same or any other behaviours, or that the results of the training and/or behaviour modification will last for any particular length of time. This Agreement may be amended only by a written instrument signed by both Client and Cowichan Canine.*
With each payment of a non-refundable fee for a set number of Consultations, Client understands that these services need to be taken up within a reasonable time limit, and that the Consultations will be forfeit if not taken up within a maximum ninety days in between each Consultation, except in the presence of extenuating circumstances beyond the Client's control. For maximum effectiveness, Consultations will normally be booked bi-weekly at the start of the behaviour modification programme, after which the frequency may taper off.*
If Client fails to give at least 24 hours notice of changes or cancellations of appointments, or is not present at time of scheduled appointment, the session fees are still due and charged. For a package deal, the missed session will still be counted as one incurred session of the package.*

16. SUMMARY

*
Which of the following "general" training goals would you like help with
Please tick all that apply.
How do you feel today about your dog's behaviour.
Please indicate which service you are signing up for at this time:*
To make your payment online, please copy and paste the above links into your browser.
*
Format: DD-MMM-YYYY
Please indicate payment method:*
*
Format: DD-MMM-YYYY
*