Unmistaken Stars Farm Sanctuary Dog Training and Behavior Consulting Application

Personal Information

Name

PrefixFirst NameLast Name

Address

Street Address

Street Address Line 2

CityState / 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

Is Your Dog Spayed or Neutered

If Yes, at what age?:

Please tell us more about your dog:

Is this your first dog?

From where did you obtain your dog?

How old was your dog when you acquired it?

Is your dog house trained?

Do you use a crate for your dog at home?

Has your dog been destructive in the past?

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?

Is your dog friendly with other people?

Is your dog cat friendly?

Does your dog have any sensitivities towards other dogs approaching? When playing? Around toys?

If yes, please explain.

How does your dog respond when seeing another dog on leash? Please explain.

Has your dog been boarded before?

If yes, was it a positive experience?

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?

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.

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?

What methods and tools have you used in training with this dog?

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?

If deemed beneficial to your dogs behavior modification plan, do you grant Unmistaken Stars (Andria Young) permission to speak with your dogs veterinarian?

Please let us know about any of the following events in the recent past. Check all that apply.

Is your dog in a

Does your dog display any signs of anxiety when alone?

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.