Private In-Home Registration Form Name* First Last Email* Family member's names and ages (if under 18)Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Home Phone*Cell Phone*Dog's Name*Breed*Sex*Dog's Birthday* Date Format: MM slash DD slash YYYY Where did you get your dog?How long have you had your dog?What vet practice do you use?*Please indicate the date your dog is due for DHLPP* Date Format: MM slash DD slash YYYY Please indicate the date your dog is due for Rabies* Date Format: MM slash DD slash YYYY What brand of dog food do you feed your dog?Please list the behaviors that are most important to you to teach your dog*Has your dog had any previous training? If so, where and for how long?*Has your dog ever been aggressive to another dog or person? If Yes, please explain*Does your dog socialize regularly with other dogs?How did you hear about Paws and Possibilities?How many dogs do you own?Do you have flexibility in your schedule to be available during weekdays from 9am-4pm to schedule an appointment?What appointment times would work best for your schedule? (check all that apply)* Weekdays Weekday Evenings Weekends Yes I agree to be added to your mailing list to receive email newsletters that include training tips and email-only discounts. Welcome! We are so pleased that you have chosen Paws and Possibilities, LLC, as your access to creating the relationship with your pet that you have always dreamed of having. During the training process, you can expect to learn how to communicate effectively with your pet and we will create simple plans to address your unique situation. We know that you have a choice when it comes to animal trainers, and we appreciate your business. If, at any point in the training process, you are not satisfied with the process, please let us know so that we may remedy the situation. It is our goal to exceed your expectations.Most of our business comes from you referring your family, friends and neighbors. If you know anyone who you think would benefit from our training program, we appreciate you passing along their information to us so that we may contact them.* Cancellation Policy: We schedule our appointments to include travel time to and from your home. If you need to cancel, kindly give 24 hours notice. Except for an emergency or an illness, you will forfeit one of your sessions for same-day cancellations. Liability Disclaimer: Animals are unpredictable. I hereby agree to indemnify and hold harmless Paws and Possibilities, LLC, its owner, employees, and agents from all claims, or claims by any member of my family or any other person accompanying me at any training sessions of Paws and Possibilities, LLC, thereto as a result of any action by any dog, including my own. Copyright Protection: I hereby agree not to copy or to release to any other persons the training materials and handouts that are given to me as a client of Paws and Possibilities, LLC, and I fully understand that all written material from Paws and Possibilities, LLC, is copyrighted and is protected under the copyright laws. I agree and accept the information stated in this agreement. NameThis field is for validation purposes and should be left unchanged.