CANINE BEHAVIOR CENTER

Please provide the following contact information:

Number of adults in household:

0 1 2 3 4 5 5+

Number of adults that work outside the home:

0 1 2 3 4 5+

How many of adults have job that is demanding and or requires travel:

0 1 2 3 4 5 5+

Number of children in home:

0 1 2 3 4 5 6 7 7+

Average age of the children in your home:

No Kids up to 3 months 6 months 1 to 3 years old 4 to 6 years old 7 to 9 years old 10 to 12 years old 13 to 15 years old 16 to 18 years old

Average number of hours per week your children participate in extra curricular activities:

No Kids 1 to 3 hrs 4 to 6 hrs 7 to 10 hrs 11 to 15 hrs 16 to 18 hrs 20 + hrs per week

Average number of weeks per year your family will be away on vacation/traveling:

1 to 2 weeks per yr. 3 to 4 weeks per yr. 5 to 6 weeks per yr. 7 to 8 weeks per yr. 10 to 12 weeks per yr. 13 plus weeks per yr.

Number of dogs in home:

0 1 2 3 4 5 6+

Age of youngest dog in home:

No dogs Less than yr old 1 to 3 yrs old 4 to 6 yrs old 7 to 9 yrs old 10 to 12 yrs old 13 plus yrs old

Age of oldest dog:

No dogs Less than yr old 1 to 3 yrs old 4 to 6 yrs old 7 to 9 yrs old 10 to 12 yrs old 13 plus yrs old

Number of cats in the home:

0 1 2 3 4 5 6+

Other species of pets:

Very small and furry (hamsters ect...)
Reptiles
Other

Resident Type:

Apartment Farm Condo Mobile Home Single Family Home Town House

Own or Rent:

Own Home Renting

Square Footage of your yard:

No yard...
100 to 500 (very small yard)
500 to 1000 (small yard)
1000 to 1500 (average yard)
2000 to 3000 (large yard)
3000 to 5000 (very large yard)
5000 plus square yards

Is your yard fenced in?

Yes No

Plan on moving soon?

Not planning on moving...
Moving in 3 to 6 months
Moving in a year
Moving in 1 1/2 yrs....
Moving in 2 plus years

If you plan to move, what type resident:

Apartment Condo Farm Mobile Home Mobile Home Park Single Family Home Town House

Select the word that best describes your lifestyle:

Low Activity Level Moderate Activity Level High Activity Level

What do you like to do in your spare time (check all that are applicable):

Walking
Reading
Jogging
Cooking
Hiking
Gardening
Bicycling
Home Improvement
Organized Sports
Internet Surfer
TV
Movies
Theater
Playing Games
Children's Activities
Entertaining
Shopping
Dating
Travel

Will you have grand children visiting you?

Yes No

Average age of your grand kids:

No grand kids visiting 0 to 3 months 6 months 1 to 3 years old 4 to 6 years old 7 to 9 years old 10 to 12 years old 13 to 15 years old 16 to 18 years ol

Do you enjoy spending time with your children pampering and grooming them?

No children Yes No

Any life altering events in the near future (marriage, divorce, baby on the way)?

Yes No

Why do you want to get a dog?

If you get a female dog, will you breed her?

Yes No

If you had to select one of these dogs to adopt, which one would you select?

Buck (Call of the Wild) Happy (7th Heaven) Hooch (Turner and Hooch Movie) Hush Puppy Lassie Rin Tin Tin

What size dog do you want?

Up to 10 lbs (very small) 11 to 15 lbs 20 to 30 lbs 35 to 45 lbs (medium) 50 to 65 lbs 70 to 100 lbs (large) 100 plus lbs

Things I expect to do with my dog (select all that is applicable)

Go on short walk with me
Go on long walks with me
Jog with me
Lay quietly by my feet
Play with my children
Play with my existing dog
run errands in the car with me
Go on vacation with me
Participate in sporting activities with me
Take to the doggie park with me

Minutes you are willing to spend grooming your dog:

Do not want to groom a dog 1 to 5 minutes 10 to 15 minutes 20 to 30 minutes 35 to 40 minutes 60 pluse minutes

Does anyone in your family have allergies?

Yes No

Amount you can afford to spend on your dogs needs on a yearly basis:

Less than $100 $150 to $300 $400 to $600 $700 to $1000 $1000 plus

If you had to get rid of your dog who would you try to place the dog with?

Friend Family Shelter Rescue Abandon the dog

Who will be the primary caregiver for the dog?

Mom Dad Adult guardian of dog (me or significant other) Child under 10 Child over 10

Did you own a dog before, if so who took care of it?

Never had a dog before Mom Dad Adult guardian of dog (me or significant other) Child under 10 Child over 10

Did you ever obedience train a dog?

Yes No

Plan on obedience training this dog?

Yes No

Method you will use to train the dog:

I Don't think the dog needs obedience training Teach the dog myself Group obedience instruction with trainer At home obedience instruction with trainer Enroll dog in obedience school with trainer Other

If your dog has a behavior problem how do you plan on trying to resolve it?

Drop dog off at shelter/rescue Abandon the dog Seek a dog trainer Read a book on the behavior problem I have no idea what to do!

Where will the dog spend his nights?

Outside Kennel Outside Dog House Family member bedroom Free run of house Crate in the house Specific room in the house Basement Garage

Where will the dog spend his days?

Outside Kennel Outside Dog House Free run of house Crate in the house Specific room in the house Basement Garage

Average hours the dog will be alone each day?

0 to 1 1 to 2 3 to 4 5 to 6 7 to 8 8 to 9 10 to 11 12 plus

Client Comments: