Kessler Kennel Farms Evaluation Form

KESSLER KENNEL FARMS

EVALUATION FORM
Have you read the "New Client Enrollment" tab on the website in its entirety? If no, please do so before continuing. *

Yes No
What services are you interested? *

Boarding Daycare (please note that enrollment in daycare is closed until after the summer) Both
If you have boarding dates in mind, please list them below. This allows us to see if we can complete an evaluation prior to their arrival. All dogs must be evaluated at least one week prior to their first scheduled boarding date, and we will not book a reservation until an evaluation date is set.
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *
Spouse Phone Number
Emergency Contact Number
E-mail *
example@example.com
Spouse Email
example@example.com
PET INFORMATION
Dog's Name *
Breed *
Age *
Weight *
How Old Was The Dog When You Acquired It? *
Gender *

Neutered Male Spayed Female Intact Male Intact Female
How Long Have Your Owned Dog? *
Where Does Your Dog Sleep At Night?
Is Your Dog House Trained?
Is Your Dog Crate Trained?
Does Your Dog Require Daily Medications? If So, please list: *
List Any Medical Problems Your Dog Has: *
Has your dog been to daycare before? If so, have they ever been dismissed & for what reason?: *
How large were their playgroup sizes?: *
What sizes were the other dogs? Small? Medium? Large?: *
What other daycares has your dog attended?: *
Has your dog ever boarded in a kennel? If so, how frequent and what was their longest board?: *
HOW DOES YOUR DOG RESPOND TO THE FOLLOWING?
Patting Head? *
Grasp Collar? *
Being Leashed? *
Behavior Problems: *

Jumping Up Chewing Digging Barking Howling Whining Urinating Stool Eating Tail Biting Tail Chasing Staring Aggression None of the above
Has your dog ever bitten another dog or person? If so, please describe in detail: *
Can your dog climb fences? If so, how high and what type?:
Does your dog resource guard? (food, sticks, holes, rocks, people, other):
Does your dog eat foreign objects? (rocks, sticks, trash, other):
Does your dog dig holes?: *
Does Your Dog Exhibit Any Of The Following Behaviors, and Why?
Cowering
Ears Back
Tail Tucked
Retreating
Hiding
Excessive Salivating
Pacing
Please Give Additional Information Regarding Fear Or Anxiety In Your Dog:
Describe Situations Where Your Dog Appears Fearful And/Or Aggressive:
How Does Your Dog Respond To The Following Situations?
When Approached While Eating: *
When Dog Is Approached While Sleeping: *
To Strangers Outside Of The House: *
To People Entering House/Yard: *
To Other Dogs In Your Home: *
Describe your dog's playstyle:
Does your dog have a prey drive?:
Does your dog eat feces? (his own or others):
If you have a fence, is your dog reactive on the fence line?:
What does their exercise look like on a daily basis?:
What commands does your dog know? (sit, down, stay, come, etc):
At this time, we can only accept dogs who can openly mix in our playgroups. We highly recommend that you make alternate arrangements for boarding in the event that your dog does not pass the evaluation process. Do you understand this? *

Yes No
Should be Empty:

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KESSLER KENNEL FARMS

PET INFORMATION

HOW DOES YOUR DOG RESPOND TO THE FOLLOWING?