Name *

First Name

Last Name

Phone Number *

(###)

###

####

Secondary Phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Number *

(###)

###

####

Housebroken? *

Yes

No

Spayed or Neutered? *

Yes

No

Crate Trained? *

Yes

No

Veterinarian's Number *

(###)

###

####

Dog's Sex

Male

Female

Please check all of the following that apply to your dog: *

Very high energy (extremely active)

Mid-level energy (moderately active)

Low energy (likes to lounge a lot)

Loves dogs

Doesn't care about other dogs

Fence jumper/climber

Door runner

Digger

Protective

Mouthy

Independent

Aggressive

Outgoing

Verbally sensitive

Timid

Pushy

Excitable

Playful

Stubborn

Will/may bite

Snaps

Shows teeth

Freezes

Trembles

Moves away

Inappropriate chewing