Unmistaken Stars Farm Sanctuary Dog Training and Behavior Consulting Application

Unmistaken Stars Farm Sanctuary Dog Training and Behavior Consulting Application
Personal Information
Name *

Prefix First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone *
Cell Phone *
Work Phone *
Your E-mail *
Alternate Contact Person:
Emergency Contact Name and Phone: *
How did you hear about Unmistaken Stars Farm Sanctuary? *
Dog Training/Behavior Consulting Information
Dog's Name *
Breed *
Age *
Sex *

M F
Is Your Dog Spayed or Neutered *

Yes No
If Yes, at what age?:
Please tell us more about your dog:
Is this your first dog? *

Yes No
From where did you obtain your dog? *
How old was your dog when you acquired it?
Is your dog house trained? *

Yes No
Do you use a crate for your dog at home? *

Yes No
Has your dog been destructive in the past? *

Yes No
Are there other dogs in your home? If yes, briefly describe *
Do you have children in the home? If yes, what age(s)? If no, is your dog child friendly? *
Personality Profile
Is your dog friendly with other dogs? *

Yes No Sometimes
Is your dog friendly with other people? *

Yes No Sometimes
Is your dog cat friendly? *

Yes No Sometimes
Does your dog have any sensitivities towards other dogs approaching? When playing? Around toys? *

Yes No Sometimes
If yes, please explain.
How does your dog respond when seeing another dog on leash? Please explain.
Has your dog been boarded before? *

Yes No
If yes, was it a positive experience? *

Yes No Never been boarded
How does your dog react to the following: Touching collar, touch him while eating? Awake him from sleeping? Take toy away while playing? *
How much daily exercise does your dog regularly receive?
Medical History
Name of Veterinarian *
Veterinarian Phone Number *
Please tell us about any illness, skin condition or other ailment your dog may have: *
List any current medications:
Does your dog have any allergies or dietary restrictions? *

Yes No
Does your dog have any fears, i.e., loud noises, thunder, etc? If so, describe. *
Please tell us any additional information we should know about your dog.
Training History & Goals
Are you experiencing any of the following problems with your dog? Please indicate. *

Chewing Jumping Pulling on leash Running away Puppy biting Stealing Resource Guarding None of the above
What specific training goals do you have for this class?
What are your long-term goals with this dog?
For private training, please include any specific information related to your dog's past history related to: Current training challenges, known bite history, Triggers/stressors.
What is your dog's training history? *

No training Group class basic Obedience titles/awards Trained yourself Group class advances Agility Puppy Kindergarten Private Training Sessions Other
What methods and tools have you used in training with this dog? *

Food or toy rewards Choke collar Prong collar Clicker training Remote collar Head halter Body harness Physical punishment, including muzzle grabs, pinning or rolling Squirt bottle Other
What is your training history with previous dogs? (Please include methods used and/or titles achieved) *
Is there a recent incident that lead you to contacting us at this time? If so, please describe.
How long has your dog been exhibiting this behavior? *
Please let us know about any of the following events in the recent past. Check all that apply. *

Marriage/divorce/separation New baby Recent move Death or illness of family member Other None
Is your dog in a *

fenced in yard electric fenced in area tether run kennel run boundary trained, no fence walked on leash
Does your dog display any signs of anxiety when alone? *

Yes No Unknown
Print First & Last Name *
Signature *
If you hit SUBMIT, and you get an error message, it is because you have not filled out ALL of the required fields above. Scroll up and the required field will be highlighted, fill that in and submit again! Please make sure all the required fields with a red asterisk (*) are complete. Thank you!
Thank you for taking the time to complete our questionnaire. This helps us to serve the needs of your dog as well as to screen potential students to help ensure safety for all.
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