Unmistaken Stars Farm Sanctuary Dog Training and Behavior Consulting Application

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*

MF
Is Your Dog Spayed or Neutered*

YesNo
If Yes, at what age?:
Please tell us more about your dog:
Is this your first dog?*

YesNo
From where did you obtain your dog?*
How old was your dog when you acquired it?
Is your dog house trained?*

YesNo
Do you use a crate for your dog at home?*

YesNo
Has your dog been destructive in the past?*

YesNo
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?*

YesNoSometimes
Is your dog friendly with other people?*

YesNoSometimes
Is your dog cat friendly?*

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

YesNoSometimes
If yes, please explain.
How does your dog respond when seeing another dog on leash? Please explain.
Has your dog been boarded before?*

YesNo
If yes, was it a positive experience?*

YesNoNever 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?*

YesNo
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.*

ChewingJumpingPulling on leashRunning awayPuppy bitingStealingResource GuardingNone 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 trainingGroup class basicObedience titles/awardsTrained yourselfGroup class advancesAgilityPuppy KindergartenPrivate Training SessionsOther
What methods and tools have you used in training with this dog?*

Food or toy rewardsChoke collarProng collarClicker trainingRemote collarHead halterBody harnessPhysical punishment, including muzzle grabs, pinning or rollingSquirt bottleOther
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.*

Marriage/divorce/separationNew babyRecent moveDeath or illness of family memberOtherNone
Is your dog in a*

fenced in yardelectric fenced in areatether runkennel runboundary trained, no fencewalked on leash
Does your dog display any signs of anxiety when alone?*

YesNoUnknown
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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