Academy Dog-Behavioral Questionnaire

Pat Miller, CBCC-KA, CPDT-KA
17816 Spielman Rd.
Fairplay, MD 21733 /


We are accepting dogs with mild to significant issues as long as the dog won’t present an unmanageable/significant risk to the safety of humans or other dogs.

Please, NO dog-reactive or people-reactive dogs. We’ll have too many, of each, moving around the farm to keep these dogs sub-threshold.

Dogs MUST be able to be crated (inside) or kenneled (outside) away from you.  You will be working in teams and there may be times when your dog cannot be with you and will need to be crated/kenneled.

Academy Dog Behavior Questionnaire
Academy Level and Date Attending:
1. Are you bringing a dog with you?
2. If bringing a dog, What is the dog's Name, Breed, Age, and Fertility Status?
3. Is this dog...
4. How long have you had him/her?
5. Brief description of behavior(s) you'd like to work on during the academy?
6. Description of prior and ongoing efforts you've made to try and modify the behavior(s). Please include information as to how effective they were or weren't.
7. Please list any medical conditions the dog may have had, what kind of treatment/medications s/he has been on or what the current status of the condition is.
8. Has the dog ever caused injury to another, human or non-human? If so, please describe.
9. Any other details you'd like to tell us?

NOTE: If you are bringing a dog, you do need to bring proof of current rabies vaccination, and DHLPP (or the equivalent). We will accept titers for the DHLPP (not rabies) with a note for your veterinarian stating that in his/her opinion the dog is adequately protected. We do not  require bordatella (kennel cough). Also know that if you are bringing a dog across state lines you are technically required to have a Health Certificate. (We don’t care, but some state trooper might get silly.)

Thank you, and Welcome to Peaceable Paws.