Reactive Class Questionnaire Name* First Last Email*Please list the email address that you want class notes & cancellations sent Phone*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dog InformationDog's Name*Dog's Breed*Male or Female?*Spayed or Neutered?*AgeWhere did you adopt or purchase your dog?*How long have you had your dog?*Are there others dogs in the household?*yesnoPlease list below their breed, age, sex and spayed or neutered.BreedAgeMale/FemaleSpay/Neuter Behavior InformationWhen ON LEASH, what does your dog do when he/she sees another dog?Check all that apply Barks Lunges Growls Snaps Ignores Wags tail/greets other dog Hides behind owner/retreat Other At what distance does this behavior happen?If other, please note the behavior.When OFF LEASH, what does your dog do when he/she sees another dog?Check all that apply Barks Lunges Growls Snaps Ignores Wags tail/greets other dog Hides behind owner/retreat Other At what distance does this behavior happen?If other, please note the behavior.How many times a week does your dog play with other dogs?*Times per weekWhereOn or off-leash Other comments about play time:Has your dog ever been in a dog fight?*yesnoHow many times?Please describe the fight below.What happened? Was either dog hurt? Were there injuries? If so, please describe. Did either dog go to the vet?What does your dog do when it sees or meets a stranger?Check all that apply Barks Lunges Growls Snaps Ignores Bites Wags tail/greets other dog Hides behind owner/retreat Other Has your dog ever bitten a person?*yesnoDid it break the skin?Please describe the incident below.What happened? Did the person see a doctor as a result of the bite? Were they provoked?Have you taken classes with your dog before, or are you working with a private trainer?*yesnoPlease list the class(es) taken, where and when.Please describe the behavior problem you are hoping to correct by attending the class:*Is your dog up to date on his vaccines including rabies?*yesnoHow did you hear about this class?