"*" indicates required fields LinkedInThis field is for validation purposes and should be left unchanged.Dog information Please submit one application for each dog who will be visiting us. Dog's Name*Breed*If a mix, list two predominant breeds in behavior:Date of birth* MM slash DD slash YYYY Color*Weight*Gender* Male Female Is your dog Spayed or Neuter* Yes No (We do require any dogs staying with us over the age of 9 months be altered)How long have you owned your dog?*YearsMonthsWhere did you get your dog? Shelter/Rescue Responsible Breeder (A breeder who only sells puppies over 8 weeks of age, can provide health testing results, temperament histories and knowledgeable breed information. All puppies have received age appropriate vet care, vaccinations, and socialization) Backyard Breeder (Any breeder selling dogs under 8 weeks of age, intentionally breeding designer crosses, considers a vet check to be appropriate “health testing”, cannot provide full histories of parental health or temperament.) Family member or friend Previous Owner Other Food and Medical InformationName of veterinarian so we can call for vaccines*NameCity Add RemoveDoes your dog have any food allergies?* Yes No If yes, please list:Does your dogs have any treat restrictions?* Yes No If yes, please list:What is your dog’s favorite treat?*Does your dog have any physical disabilities or medical conditions?* Yes No If yes, please explain:If medication is used to control the condition, please provide name(s) and dosage:Does your dog have any sensitive areas on his/her body?* Yes No If yes, where?Does your dog have any bathroom-related issues or concerns?* Yes No If yes, please explain:Does your dog have any intolerance to hot or cold weather when on walks?* Yes No If yes, please list:When was the last time your dog visited a veterinarian?Behavior Information - GeneralWhere are your dog’s favorite petting spots?*Check the box below that best represents your dog’s overall level of exercise routine:* Couch Potato: Spends days sleeping, occasional walks and/or playtime with humans or other dogs. Mild Exerciser: Short daily walks and/or regular playtime with human or other dogs. Moderate Exerciser: Long or multiple walks daily and/or regular playtime with human or dogs. Athlete: Regular jogs/runs and/or regular participation in a dog sport activity such as agility, flyball, or Frisbee, etc. Check the box below that best represents how often your dog goes for a walk:* Never Less than once per week 1-2 times per week 3-4 times per week Once per day 2+ times per day How did your dog get his/her obedience training? (Please check all that apply)* None Attended one group class Attended more than one level of group classes (beginner and intermediate, etc.) Dog was sent to a board and train program Private sessions in home Other Please explain:Which of the following best describes the use of obedience cues with your dog at home?* Key part of daily communication Used when we go on walks or have people over Used occasionally to better control behavior Rarely used What does your dog do to show he/she is happy?*What does your dog do to show he/she is upset?*Has your dog ever climbed/jumped a fence?* Yes No If yes, height of fence?Has your dog ever gotten away from someone when out for a walk?* Yes No If yes, please explain the circumstances:Is it okay if we were to give your dog a natural calming supplement during Thunderstorms? Yes No Is your dog ever frightened, nervous, or anxious?* Yes No If yes, please explain.What are your dog’s favorite toys?*Where does your dog sleep at night?What does your dog do during the day when it’s not actively being interacted with?How do you feel your personal relationship with your dog is? 1-Poor 2 3 4 5-Excellent What is the main reason you are seeking training?How would you rate your dog’s anxiety: 1-Not anxious at all 2 3 4 5-Extremely anxious Has a veterinary behaviorist or other professional ever diagnosed your dog with anxiety? Yes No Not Sure Behavior Towards People/Other DogsHow does your dog react to meeting a new person?*On LeashOff Leash Add RemoveHow does your dog react to people or dogs approaching his/her food or toy?*Has your dog ever bitten a person or another animal?* Yes No If yes, what were the circumstances and how did you respond?Please describe any injuries (if any)Are there any particular types of people or dogs your dog seems to automatically fear or dislike?* Yes No If yes, please describeHow does your dog react when seeing other dogs?* Ignores other dogs Happy to see other dogs and ... Scared when seeing other dogs and ... Reactive towards other dogs by ... Other, please describe: Happy to see other dogs and...* Does not try to engage them Wants to engage playfully with them Scared when seeing other dogs and ...* Does not try to engage them Attempts friendly engagement Reactive towards other dogs by ...* Vocalizing (barks, growls, snarls) only Vocalizing and tries to move away from other dogs Vocalizing and lunges at other dogs Other, please describe:*Which of the following best describes your dog’s level socialization with other dogs:* None – No knowledge of other dog interaction Minimal – On leash encounters only Moderate – Some off-leash playtime on occasion with visitor’s/neighbor’s/friend’s dog(s) Extensive – Regular visits to dog social events, off-leash dog parks, dog daycare, etc. Is there anything else we should know about your dog?
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