Owner's Name Email Best Phone Number Street City State Zip Code Dog's Name Breed/Mix Dog's Age Sex MaleFemale Spayed/Neutered YesNo Dog was acquired from: BreederKennelRescue ShelterPet StoreOther How many adults reside in your household? 1 2 3 4 5 or more How many children reside in your household? 1 2 3 4 5 or more Ages of children Have you previously owned a dog? YesNo Have you ever attended an obedience class? YesNo If yes, where was the class? What commands does your dog currently obey? On a typical day, please indicate the percentage of time your dog is inside/outside: 10% inside/90% outside25% inside/75% outside50% inside/50% outside75% inside/25% outside90% inside/10% outside On a typical day, what percentage of time is your dog alone? 10% or less25%50%75%90% or more Do you currently crate your dog? YesNo Do you have a fenced yard? yes no What is your primary method of exercising your dog? What words best describe your dog? (hold down alt/command to select multiple entries) ShyFearfulBitesAggressive with peopleAggressive with dogsGrowlsPushyJumpsDestructiveNoisyCalmObedientProtectiveExcessive EnergyExcessive BarkingOther Send
