$8.00 - Paid Not Paid
Needs rabies________
Dane County 4-H Dog Training Informational Form
Dog training will take place at the Alliant Energy Center, in and around the arena or other
barns on the grounds.
Handler Name ___________________________________ Grade as of January 1________
Address ____________________________ City _______________
Zip code __________
Parents/Guardians ____________________________________________________________
Home Phone ________________ Cell Phone ______________ Work Phone _______________
Club Name ___________________________________________________________________
Other Emergency Contacts (in the event we are unable to reach parent(s)/guardian):
Name
_
Name
_
Phone
Relationship
Phone
Relationship
Doctor name _________________________ Preferred Hospital _________________________
Please read carefully
The arena and other barns at times may have sawdust, wood shavings, or a dirt floor depending on
what other activities are being held in the facilities. Other animals use these facilities throughout the year.
It is very important that we know of any allergies or special conditions that your child might have prior
to the beginning of dog training. Please complete the information below.
Allergies to food, medications, environment, etc. (please specify) ___________________________________
__________________________________________________________________________________________
Expectations
As a 4-H member, you are expected to adhere to the behavior expectations that you have
signed when you turned in your enrollment forms.
Other expectations:








Remember it is a privilege to be a 4-H member!
No abuse or neglect of an animal.
No willful disrespect for others, use of profane language or behavior unbecoming to a Dane County 4-H
member.
Have respect for your group trainer and the personal and training space of others participating in your
obedience class.
Respect others, the building and facilities when coming and going from the Alliant Energy Center.
Damage to any public or private property beyond its normal use is at the expense of the member.
If your dog is determined at any time by the Committee Members or Instructors to be uncontrollable,
vicious, or unmanageable in or out of a group setting, the dog will be excused from the training
program.
Clean up after yourself and your dog.
Revised Dec 2015
Please bring 2 copies of a Rabies Vaccination from a Veterinarian for all dogs participating in
the Dane County 4-H Dog Training Program, current through July 18, 2016.
First Dog Name___________________________ Breed ___________________ Age _______
Sex of dog Male or Female - Altered Yes or No Size of dog Small Medium Large
Has this dog been trained before? What level _______________
Do you believe that your dog is ready for the next level? Please be honest. Yes or No
Preferred obedience training time
6:00PM
or
7:30PM
Do not fill in- To be filled out at Check in day
Temperament Good Fair Poor
Condition of dog Good Fair Poor
Class to be entered in for 2016 Obedience training _______________________________
Time of Training (circle one) Training: 6:00 p.m.
Training: 7:30 p.m.
Showmanship: Yes or No
$8.00 Paid ______ Not paid ______
Second Dog Name___________________________ Breed ___________________ Age ____
Sex of dog Male or Female - Altered Yes or No Size of dog Small Medium Large
Has this dog been trained before? What level _______________
Do you believe that your dog is ready for the next level? Please be honest. Yes or No
Preferred obedience training time
6:00PM
or
7:30PM
Do not fill in- To be filled out at Check in day
Temperament Good Fair Poor
Condition of dog Good Fair Poor
Class to be entered in for 2016 Obedience training _______________________________
Time of Training (circle one) Training: 6:00 p.m.
Training: 7:30 p.m.
Showmanship: Yes or No
$8.00 Paid ______ Not paid ______
Third Dog Name___________________________ Breed ___________________ Age ____
Sex of dog Male or Female - Altered Yes or No Size of dog Small Medium Large
Has this dog been trained before? What level _______________
Do you believe that your dog is ready for the next level? Please be honest. Yes or No
Preferred obedience training time
6:00PM
or
7:30PM
Do not fill in- To be filled out at Check in day
Temperament Good Fair Poor
Condition of dog Good Fair Poor
Class to be entered in for 2016 Obedience training _______________________________
Time of Training (circle one)
Showmanship: Yes or No
Training: 6:00 p.m.
Training: 7:30 p.m.
$8.00 Paid ______ Not paid ______