This Form cannot be submitted until the missing
fields (labelled below in red) have been filled in
K9 Country Club Client Questionnaire
Please note that all fields followed by an asterisk must be filled in.
Owner's name(s)*
Phone number*
Dog's name*
Dog's current age*
Breed*
If a mix, list two predominant breeds apparent
GENERAL INFORMATION
How long have you owned your dog?*
Where did you get your dog?*
What knowledge do you have of your dog's history?*
How would you describe your dog's energy level?*
Low
Medium
High
What other pets do you have in your household? *
How does your dog get along with your other pets (if any)?
What kinds of games do you play with your dog?*
Does your dog like to play in water?*
Yes
No
How does your dog behave during a bath?*
How does your dog react to having his/her nails trimmed?*
Is your dog crate trained?*
Yes
No
If yes, do you currently use a crate regularly?
Yes
No
Where does your dog sleep?*
Crate
Dog bed
Other
If you are applying for our daycare program, what is the reason? (Please check all that apply)*
Provide play time with other dogs
Prevent dog from being home alone
Exercise
Recommended by a pet professional (trainer, veterinarian, etc.)
Other
If daycare was recommended by a pet professional, what is the reason?
Does your dog show signs of separation anxiety?*
Yes
No
What other sources of exercise does your dog have? *
HEALTH INFORMATION
Date of last rabies vaccination*
Date of last DHLP/P vaccination*
Date of last Bordetella vaccination*
Date of last fecal parasite screening*
Date of last Giardia screening*
What flea/tick control and prevention method do you use? *
Does your dog have any allergies?*
Yes
No
If yes, please describe any allergies
Does your dog have any medical conditions?*
Yes
No
If yes, please describe any medical condition
If medication is used to control a medical condition, please list name and dose
Does your dog have any physical disabilities?*
Yes
No
If yes, please describe the disability and cause
What restrictions need to be placed on your dog's activities or movements?*
None
No jumping
No running
No rough play
No contact with other dogs
Other
If other, please explain
Does your dog have any sensitive areas on his/her body?*
Yes
No
If yes, please describe
What type of food do you feed your dog?*
Dry kibble
Canned
Raw/natural
Brand of food*
Feeding schedule*
Does your dog have any potty-related issues or concerns?*
Yes
No
If yes, please explain
On what type of surface does your dog generally go potty?*
Grass
Mulch or bark
Gravel
Pee pads
Other
What word do you use to get your dog to eliminate (go potty)?*
SOCIALIZATION
Which of the following options best describes your dog's level of socialization with other dogs?*
None - No knowledge of other dog interaction
Minimal - On leash encounters only
Moderate - Some off-leash playtime on occasion with familiar dogs
Extensive - Regular visits to dog social events, off-leash dog parks, dog daycare, etc.
Has your dog had any problems previously in an off-leash social environment? (Please check all that apply)*
Altercation or fight at a public dog park
Altercation or fight with a neighbor's or friend's dog
Fearful reaction to a group of dogs
Dismissed from a prior daycare or social playgroup program
Other
None
If any above, please explain
OBEDIENCE TRAINING
Which commands does your dog know?
Sit
Stay
Down
Come
Heel
Roll over
Kisses
High five
Shake
Other
How did your dog receive his/her obedience training?*
Attended one group class
Attended more than one level of group classes (beginner & intermediate, for example)
Dog was sent to a board and and train program
Private sessions with a professional in the home
Other
None
If your dog attended obedience training classes, where were the classes held?
Which option best describes the use of obedience cues with your dog at home?*
Key part of daily communication
Used when on walks or when other people are in the home
Used occasionally to better control behavior
Rarely used
Never used
BEHAVIOR INFORMATION
Does your dog have any problems in any of the following areas*
Mouthing
House-training
Barking
Digging
Ignoring commands
None
If any problem behaviors are checked above, please describe
How does your dog behave around children*
How does your dog react to a stranger coming into your home or yard?*
Do visitors bring their dogs to your home?*
Yes
No
If yes, how does your dog react?
How does your dog behave behind a gate or fence when another dog approaches?*
How does your dog behave behind a gate or fence when a stranger approaches?*
How does your dog react to another dog approaching him/her while on a walk?*
Are there any types of people your dog seems to automatically fear or dislike?*
Yes
No
If yes, please explain
Has your dog ever growled at someone?*
Yes
No
If yes, what were the circumstances?
Has your dog ever bitten a person?*
Yes
No
If yes, what were the circumstances?
Please describe the injuries, if any
Has your dog ever bitten a dog or other small animal?*
Yes
No
If yes, what were the circumstances?
Please describe the injuries, if any
Has your dog ever chased (or tried to chase) someone on a skateboard or bicycle?*
Yes
No
If yes, please describe the circumstances.
Has your dog ever chased (or tried to chase) a small animal?*
Yes
No
If yes, please describe the circumstances.
Has your dog ever growled or snapped at a PERSON who has taken away food or toys from him/her?*
Yes
No
If yes, please describe the circumstances.
Has your dog ever growled or snapped at a DOG who has approached his/her food or toys?*
Yes
No
If yes, please describe the circumstances.
Has your dog ever climbed or jumped a fence?*
Yes
No
If yes, please describe the circumstances.
How high was the fence?
What type of fence?
Has your dog ever escaped from your house or yard?*
Yes
No
If yes, please describe the circumstances.
Is your dog frightened by thunderstorms?*
Yes
No
If yes, please describe your dog's typical behavior during thunderstorms.
What helps to relax or calm your dog's fear?
Is your dog frightened or nervous in other circumstances?*
Yes
No
If yes, please explain.
Please add any other comments or information about your dog that you think might be helpful for us. Thank you!
Please enter the word that you see below.
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Requirements
What to Pack
FAQs
A Day at Camp
Camp Photos
Safe & Fun Dog Play