TN VALLEY WORKING DOGS
Membership Application

DATE:_______________________________

NAME:_________________________________________________________________

ADDRESS:______________________________________________________________

CITY, STATE, ZIPCODE:__________________________________________________

PHONE:_______________FAX:______________EMAIL:________________________

OCCUPATION:__________________________________________________________

EMPLOYER’S ADDRESS:_________________________________________________

DATE OF BIRTH:___________________________SEX:_________________________

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How did you hear about TN VALLEY ?___________________________________

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Previous Dog Training Experience?___________________________________________

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Previous Training Club Affiliations?__________________________________________

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Reasons for Joining TN Valley?______________________________________________

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Goals?__________________________________________________________________________________________________________________________________________________________________________________________________________________

PLEASE FILL OUT PAGE 2 FOR EACH DOG YOU PLAN TO TRAIN

DOGS’ NAME:___________________________________________________________

DATE OF BIRTH:________________________________SEX:____________________

BREED:______________________TITLES:___________________________________

VETERINARIANS NAME:_________________________________________________

ADDRESS:___________________________________PHONE:____________________

HEALTH HISTORY AND IMMUNIZATIONS:_________________________________

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WORK HISTORY:     (please note any problems either physical or training related that                                                 will help us to know your dog better.)

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TEMPERAMENT:       (please describe your dog’s temperament with adults, children,                                      other dogs, etc.)

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WHAT ARE YOUR IMMEDIATE AND LONG RANGE GOALS WITH THIS DOG?

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COMMENTS?

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