Canine Management - Registration Form Human Information Names ___________________________________________________________________________________ Primary Phone________________________________ Cell ________________________________ Text Y / N Email _________________________________________________ Alternate ___________________________ Facebook Y / N _________________________________________ Alternate ___________________________ * Check mark your preferred contact methods above. Street Address___________________________________________ Mailing ____________________________ City __________________________________________________ Postal Code _________________________ Emergency Contact ______________________________________ Phone______________________________ * If you, or your chosen contact person is not available during an emergency, Christine Yake will make decisions on your behalf, keeping your dogs best interest in mind. **Initials _____________ Date _______________

Medical Information Veterinarian Clinic _______________________________________ Phone_____________________________ Date of Last Exam, Current Vaccinations or Titer Tests _____________________________________________ Health Concerns ________________________________________ Pet Insurance _______________________ Flea Treatment Product ___________________________________ Last Treated _________________________ Worm Treatment Product _________________________________ Last Treated _________________________ Other Medications __________________________________________________________________________ __________________________________________________________________________________________ Additional Health Information _________________________________________________________________ __________________________________________________________________________________________ * If applicable, you should notify your veterinarian clinic that your dog will be in the care of Christine Yake. * Christine Yake will treat your dog as if they were her very own, keeping them as safe and healthy as possible. Accidental injuries and health issues can arise suddenly and it’s important to think about before leaving your pet in the care of anyone else. Detail your medical wishes, financial limitations for accident, diagnosis, illness, etc. ______________________ __________________________________________________________________________________________ * Boarding clients are required to leave their credit card information on file at the veterinarian clinic listed on this form and discuss the details of your medical wishes with your clinic as well. * All financial expenses are the full responsibility of you, the owner. **Signed __________________________

Canine Information Name / Nickname________________________________________Breed______________________________ Sex M / F Altered Yes / No

Age Aquired _____ Birthdate __________________________________

From Where / History_________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

Diet & Exercise Brand of Food __________________________________________ Amount ____________________________ Sensitivities ____________________________________________ Times Fed __________________________ Eating Habits ___________________________________________ Guarding Issues _____________________ Treats, Chews or Bones ______________________________________________________________________ Exercise and Elimination routine _______________________________________________________________ __________________________________________________________________________________________ Additional Notes _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________

Grooming - Skin, Coat, and Nails Skin or Coat Issues _________________________________________________________________________ Nail Trim Frequency or Issues _________________________________________________________________ Sensitive or Painful Areas ____________________________________________________________________ Does your dog enjoy, tolerate, fear or hate grooming _______________________________________________ What is your grooming routine at home _________________________________________________________ List your tools _____________________________________________________________________________ *Comb

*Slicker Brush

*Pin Brush

*Furminator

Does your dog visit a professional Groomer Yes / No

*Rake

*Shedding Blade

*Rubber Curry

If yes, Where _________________________________

Approx. How Often *2 Weeks *6 Weeks *2-6 Months *6-12 Months *As Needed *Other ____________ * Please note that while on trail walks with Christine, dogs may get wet and dirty. Christine will towel dry dogs before returning them home, but you may want to dog proof an area for them to be left in if you are not home. **SPECIAL INSTRUCTIONS for wet dog drop off. (or if you have a dog that likes to roll in things) __________________________________________________________________________________________ * Christine will notify you of any general maintenance or health related issues that she notices. Boarding clients may receive minor sanitary clips or feet tidy on the bottom if needed.

Behaviour, Training and Socializing Describe life with your dog in a few words _______________________________________________________ __________________________________________________________________________________________ Future Goals _______________________________________________________________________________ What prompted you to seek training help_________________________________________________________ Previous Training History ____________________________________________________________________ Obedience Commands _______________________________________________________________________ __________________________________________________________________________________________ Where does your dog sleep at night________________________ While you are at out_____________________ Crate Trained Y / N When does your dog use it? Bedtime When Alone Travelling Other______________ Does your dog enjoy the crate Y / N Sleep in the crate while door open Y / N Allowed on your furniture Y / N Describe your dogs social life and friends ________________________________________________________ __________________________________________________________________________________________ Does your dog have Separation Anxiety, if yes, describe ____________________________________________ __________________________________________________________________________________________

Does your dog chew your stuff Y / N Raid Garbage Y / N Counter Surf Y / N Other _____________________ Favourite things ______________________________________Dislikes _______________________________ Reaction to other dogs on walks__________________________________ Strangers _____________________ Sudden Noises___________________________ Children____________________ Prey___________________ Any history of growling, snapping, or lunging at anyone, including you, other animal, vehicle, bike __________ __________________________________________________________________________________________ Do you allow your dog off leash______ Problems__________________________________________________ Does your dog roll in smelly things ____ Eat things _____ Chase things_________ Other _________________ Does your dog check in with you on walks or are they more interested in everything else __________________ Does your dog react to wind storms, thunder, or unusual things _______________________________________ Does your dog Jump Fences____ Jump on People____ Dig Holes____ (recreation or escape) Steal Things ____ Additional information to help me care for your dog________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Thank you for entrusting me with your precious pooch. Keep in touch. ~ Christine Yake

Pick up / Drop off information. Dates. Key Codes, Specific Preferences _______________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

2014 Rates Walk $25 Single Dog Courtenay / Comox + $15 Additional Dog. $30-40 for Difficult Dogs Boarding $35-$40 (Check out 9am or additional day charge) Private Lesson $60

Cancellation and Payment Policies Private Lessons, Walks and Day Care require 24 hr. Cancellation notice to avoid $15 Cancellation fee. Boarding, 72 hr. Cancellation notice. Pre-payment required before your departure. Cancellation fee 50%. Payment of Cash, Cheque, E-mail Money Transfers accepted.

Technical Jargon As legal owner of my dog, I hereby waive and release Canine Management, and Christine Yake from any and all liability of any nature, for injury or damage which I or my dog 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 any such damage or injury while boarding my dog, attending any training session, function or activity or while on the grounds or the surrounding area thereto. In consideration of and as inducement to the acceptance of my application by Canine Management, I hereby to agree to indemnify and hold harmless Canine Management and its owners, employees and agents from any and all claims, or claims by any member of my family or any other person accompanying me to any training session, function or activity of Canine Management or while on the grounds or the surrounding area there to as a result of any action by any dog, including my own. Signature ______________________________________ Date _______________________________________ Additional Notes __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________