Courteous Canine, Inc.

We provide dog training, behavior consulting, dog sport, daycare plus and in home boarding and board and train services. Our staff are certified or working under the supervision of certified trainer.

Name*

Email*

Address*

Phone*

Other Phone

Pet Name*

Breed*

Birthday*

Weight*

Sex*

Spayed or Neutered *YesNoUnknown

Age when Spayed or Neutered?Pediatric6 months AdultUnknown

How many pounds does your dog weigh? *

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

Has your dog ever bitten a person?*YesNo

Has your dog ever bitten another dog? *YesNo

Does your dog have any behavior issues such as aggression, reactivity, etc?*YesNo

Has your dog ever attended another daycare?*YesNo

Can your dog handle being touched on the head, neck, shoulders, etc.?*YesNo

Is your dog ok with collar grabs and other handling?*YesNo

Does your dog crate well without vocalizing or signs of distress?*YesNo

What is your dog's play style (rough, relaxed, energetic, etc)?*

What is your dog's energy level?*High energyMedium energyLow energy

Does your dog play well with small dogs or big dogs or both?*Small DogsBig DogsBoth

What kind of treats can your dog have?*Courteous Canine treat, i.e. CheeriosTreat supplied by parent onlyOther

Other

Does your dog have any medical concerns or allergies? If so, please describe.**

Is your dog microchipped?*YesNoUnknown

People Authorized to Pick Up Your Pet:*

Emergency Contact Name:*

Emergency Contact Phone:*

Medication Schedule/Notes:

Feeding Schedule/Notes:

Other notes:

Veterinarian used:*

By selecting the field below I agree to provide up to date shot records for my dog prior to my first appointment by emailing shot records to [email protected]*

Current - CCinc Waiver Sep 2025.docx

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