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Dog Walking Form
Your Details
Your Name
Phone
Email
Street Address
City
Postal / Zip code
Emergency Contact Name
Emergency Contact Number
Any security information in your home, gate code/alarm etc:
Your Dog's Details
Dog's Name
Sex
Choose an option
Breed
Neutured?
Choose an option
Date of Birth
Date of last season if applicable
How long have you owned your dog?
Dogs history (adopted/owned since puppy)
Date of last immunisation including Kennel Cough?
Any Allergies?
Please list any pre-existing or current health conditions:
Please list any medication your dog is currently taking:
Please list any sensitive areas on his/her body:
Please indicate any restrictions on your dog’s activity (any physical limitations):
Is your dog allowed treats while under the care of StarBarks?
Yes
No
Your VET's Details
Practice Name
Vet Contact No.
Vets Name
Vet Address
Social Skills and Behaviour
Please give a brief description of any formal training your dog has received:
How does your dog react to people when on walks?:
What do you do if your dog does something wrong?
How does your dog react to other dogs when on walks?:
What do you do if your dog does something right?
Please describe your dog’s general behaviour and energy levels (both inside and out):
Please indicate if your dog is anxious or frightened by any of the follow:
Noises
Actions
Objects
Bicycles
Scooters
Runners
Types of Dog
Types of People
If any selected, please explain:
Does your dog have a specific cue to “go to the bathroom":
Does your dog behave differently on and off lead?:
Does your dog play off lead with other dogs?:
Does your dog live with children?
How does your dog behave around new children?:
Has your dog ever jumped on someone, if yes, please describe:
Has your dog ever shown aggression to someone, if yes, please describe
Has your dog ever shown aggression to another dog, if yes, please describe:
Does your dog allow you to take things out of his/her mouth:
Please indicate your usual walk (e.g usually on lead, usually off lead etc)
Please indicate the dogs level of recall (e.g good, poor, hit and miss!!)
Please give details of pick up and drop off routine (e.g where the dog should be left)
How did you hear about Starbarks Dog Training?
Please give any other information you think would be useful to enable us to give your dog the best possible care while with us at StarBarks.
I agree to StarBarks having the right to allow my dog off the lead and understand that all terms and conditions remain the same.
PLEASE NOTE: Any cancellations or amendments made within 48 hours will be subject to full charge
I accept terms & conditions
View Terms & Conditions
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