Courteous Canine, Inc.

Name*

Email*

Address*

Phone*

What pronoun do you prefer?

She/Her/HersHe/Him/HisThey/Them/Theirs

How did you hear about us?*

Requested Dates for Overnight:*

Pet Name*

Breed*

Birthday*

Sex*

Spayed or Neutered *

YesNoUnknown

How long have you owned this dog? (rounded in years)*

Where did you get this dog? (Please list name of shelter, breeder, etc.)*

In addition to you, list the names and ages of all people and animals in the household, including yourself*

Is your dog aggressive towards people? *

No/yes

Has your dog ever bitten a person?

No/yes

Please describe any incidents.

Is your dog aggressive towards other dogs? *

No/yes

Has your dog ever bitten another dog?

No/yes

Please describe any incidents.

Is your dog aggressive toward small animals (cats, chickens, etc.)? *

No/yes

Please describe any incidents.

Is your dog reactive and/or fearful of other things (bikes, vacuum, etc.)? *

No/yes

If yes, please describe:

Is your dog reactive and/or fearful of any of the following (select all that apply):? *

If yes, please explain:

Does your dog pull on the leash or have any problems while walking? *

No/yes

How often do you walk your dog?*

List any equipment you use to walk your dog: *

Does your dog jump/climb fences? *

No/yes

If yes, what type/height:

Do you have a fenced yard for your dog? *

No/yes

If you don't have a fenced yard, how do you take your dog outside (check all that apply):

What type of exercise does your dog get on a regular basis (at least one time per week or more)? Check all that apply: *

If Other, please describe:

Please list how your dog rides in a car: *

If Other, please describe:

Does your dog ride well in a car?*

No/yes

If no or sometimes please explain what the problems are:

Which most closely describes how your dog eats?*

Food is the best part of the day – barely stops to breathe Food is good – eats everything at a reasonable paceFood is so/so – may or may not finish a meal or needs "extras" to make it appetizingFree feed – food is out all the time

Does your dog bark a lot? *

No/yes

If so, list what he/she barks at (or situations in which they bark) and anything you've done to try to prevent it.

Does your dog jump on company? *

No/yes

Are you okay with this or is it something you prefer they not do?

I'm okay with itI would prefer they not do it

Does your dog jump on furniture? *

YesNo

Are you okay with this or is it something you prefer they not do?

I'm okay with itI would prefer they not do it

Does your dog chew or destroy any human items in the house or yard? *

No/yes

Do they like to play with toys? *

No/yes

What kind of toys does your dog have/how many?*

What, if any, chewies do you offer them (rawhides, bones, etc.)?*

Is your dog house trained? *

YesNoPartly

Where does your dog stay while you are gone?*

Is your dog loud or destructive while you are gone? *

No/yes

If yes, please describe in detail:

Where does your dog spend most of their time when you are home?*

Where does your dog sleep at night (dogs may need to be kenneled at night for safety)?*

VACCINE INFO: DHLPP*

Expiry Date

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Please upload a Photo or PDF document.

Bordetella - Expiry Date:*

Canine Influenza - Expiry Date:

Leptospirosis - Expiry Date:

Rabies - Expiry date:*

In-Home Boarding Intake Form

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