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Behavior Questionnaire Form
Name: ___________________________Phone:______________
E-Mail:___________________________________________
Mailing Address:________________________________________
City:___________________________ State:_____ Zip:_______
Dog’s Name:______________________ Breed:_____________
Color:___________ Dog’s Birthday__________ Male/Female Spayed/Neutered/Intact
Date of Vaccinations: Bordatella________Rabies________DHLPP________
Name of Vet:_________________________Vet’s Phone #___________
Has this dog ever bitten another dog? If, yes, please explain______________________
Has this dog ever bitten or lunged at a person? If yes, please explain__________________
Whom can we thank for telling you about Bark Park?_________________________
Name of Group Class or Goal of Private Session___________________________
Is this your first dog?_____ Breeds you have lived with:_____________________
Have you had previous dog training experience?_____ If yes, please describe._____________
How much time are you willing to spend DAILY to help modify this behavior?________________
Other pets in household? ___ If yes, please list __________________________
Other humans in household? If yes, please list ___________________________
How is dog exercised? On Leash Off Leash How long does exercise last?____________
Please List Dog’s Food/Treats:__________________________________
Please List Dog’s Medications__________________________________
Please list Dog’s illnesses____________________________________
Has Dog had any previous training? _____ If yes, please describe _________________
What exactly is the unwanted behavior?_______________________________
When does it occur? _____________________________________
How often does it occur?____________________________________
What type of treats or toys does your dog like?____________________________
When does the dog get stiff/bark/growl or show teeth? ________________________
How do you punish the dog? ___________________________________
Liability Release
Owner (owner of dog, client of Bark Park Dog Daycare, and handler of dog) agrees that Amy Donohue and Staff and Bark Park Dog Daycare and/or any independent contractor offering
services at Bark Park Dog Daycare will not be liable for any damage or loss resulting from failure of the dog to respond to any cues or commands taught to the dog by Amy Donohue and Staff
and Bark Park Dog Daycare or resulting from counseling and advice supplied to owners of dog. Dog’s behavior now and in the future is solely the responsibility of the owners (client) of the
dog. Should any behavior on the dog’s part now or in the future result in damage to the property, owners, or person of some third party, owner agrees to assume full responsibility to such
third party for any and all such damage, and to absolve Amy Donohue and Staff and Bark Park Dog Daycare from any and all obligations to pay such damage to a third party. All dogs are
trained or otherwise handled or cared for or if owner receives instruction by Amy Donohue and Staff and Bark Park Dog Daycare without any liability whatsoever on Amy Donohue and Staff
and Bark Park Dog Daycare for loss, damage from disease, death, running away, theft, fire, injury to persons, other dogs or property by said dog, or other unavoidable causes. In the event of
in-home training provided by Amy Donohue and Staff and Bark Park Dog Daycare whether owners are home or not, owners agree to absolve Amy Donohue and Staff and Bark Park Dog
Daycare from any and all liability whatsoever for loss or damage to property. In the event of training provided at the location of Bark Park Dog Daycare, 75 Kostka Drive, Masaryktown, FL
34604, owner agrees to absolve Amy Donohue and Staff and Bark Park Dog Daycare and/or any independent contractor offering services at Bark Park Dog Daycare from any and all liability
whatsoever for loss or damage to property, or injury to dog, or owner, or handler and to hold her harmless therefore.
Signature of Owner_____________________________Date_________________________
Name of minor:________________________ Age _____
Signature of parent/legal guardian_________________________
Bark Park Dog Daycare, 75 Kostka Drive, Masaryktown, FL 34604
Phone: 352-796-1888 Fax: 352-796-1860
E-mail: questions@barkparkdogdaycare.com Website: www.BarkParkDogDaycare,com
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