| Owners last name: |
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| How did you hear about CLUB Fido? |
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| Dog's Name: |
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| Date you acquired dog: |
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| What age was it done? |
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| Where did you get your dog? |
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| If adopted, do you have any knowledge of your dog's past history? |
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| Does your dog like children? |
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| How does your dog behave around children? |
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| Are there other animals in your household? If yes, please list type, sex and age of each? |
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Health and Grooming
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| Does your dog have a problem with fleas? |
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| Allergies? |
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| Does your dog have Dysplasia? |
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| If yes, what restrictions need to be placed on your dog's activities or movements? |
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| Does your dog have any sensitivity on his/her body? |
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| What are your dog's favorite petting spots? |
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Behavior
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| Does your dog act afraid of any particular items or noises? |
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| If so, explain: |
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| How does your dog react to strangers coming into your yard? |
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| Does your dog ever bark or growl at anyone passing outside your home or yard? |
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| Are there any kinds of people your dog fear's or dislikes? |
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| How does your dog react to puppies? |
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| Has your dog ever growled at someone? |
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| What were the circumstances? |
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| Has your dog ever bitten someone? |
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| What were the circumstances? |
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Does your dog have any problems in any of the following areas: (If so, please explain)
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| Mouthiness: |
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| House Training: |
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| Barking: |
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| Digging: |
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| Jumping: |
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| Other: |
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| Has your dog ever growled or snapped at anyone who has taken his/ her food or toys away from him/ her? |
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| What were the circumstances? |
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| Has your dog ever shared his/her food or toys with other animals? |
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| Does your dog play with any toys? |
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| If yes, what kind of toys does your dog like and what games does he/ she play? |
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| Does your dog play with other dogs? |
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| Have you ever had any formal obedience training for your dog? |
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| If yes, where and when? |
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| What commands does your dog know? |
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| Other comments about your dog that you feel might be helpful: |
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