To start let's get your contact info.

First Name *

Last Name *

Street Address (no PO boxes) *

City, State *

Zip *

Phone *

Email *

Now tell us a little about your dog.

Pet's Name *

Breed(s) *

Pet's Age *

Dog's Sex *

Male / Neutered
Male / Intact
Female / Spayed
Female / Intact

Where did you get your pet? *

Breeder
City/County Shelter
Nonprofit Dog Rescue
Private party online Facebook/Craigslist
Adoption Website (Petfinder/Adopt a Pet)
Friend / Family
Other

How long have you had your pet? *

Next we need to know about your dog's daily life.

Where does your dog hang out during the day? *

In the house free to roam with people around
Alone in the house free to roam
Outside with people home
Outside with no one home
In a crate/play yard
In the garage
In a separate room
With me at work

Where does the dog sleep at night? *

In bed with me/us
In a crate/ play yard
On a dog bed in our bedroom
In the house / wherever they want
In the garage
Outside

You're about halfway through!

Let's find out if your dog is a foodie.

How many times a day does your dog eat? Select from the drop down menu *

What type of food does your dog eat? Include brand and form (kibble/dehydrated/raw) *

Where does your dog eat? *

In a crate/play yard
In a room indoors
In the garage
Outside
Other

Does your pet display any of the following behaviors around food: *

Eating quickly
Growling, freezing, or lowering their head into the bowl when someone is nearby or approaches
Growling, freezing, or lowering their head into the bowl when someone touches them
Growling, freezing, or lowering their head into the bowl when someone takes their food away
Snapping or biting when someone is nearby

Has your dog ever bit a dog or person where feeding time was involved? *

Let's find the activity level that best describes your dog.

How many times a week does your dog go for a walk? *

Who walks your dog? *

Myself
Family member / Friend
Dog Walker
N/A -No one

How long does your dog walk? (Miles or minutes) *

What length of leash does your dog walk with? *

1-3 foot tab leash
4-6 foot standard leash
Double clip leash
Retractable leash
Crossbody/Belt Hands Free leash
Other: Please share

Now a quick health check.

Which vaccines is your pet up-to-date on? *

Rabies
Bordatella
Distemper/Parvo

Does your pet have any allergies or sensitivities? *

Does your dog have stomach issues such as vomiting, diarrhea or other GI upset? *

Yes
No
Ongoing

Is your pet taking any supplements? (if yes, please list) *

Is your pet taking any medications? (if yes, please list) *

Does your pet have any chronic or ongoing medical conditions? If so, please explain: *

Play time!

What are your dog's favorite types of toys? *

Stuffies
Balls
Rubber/latex toys
Toys with noise (squeakers/crinkles/grunts)
Hard chew toys
Rope toys
Enrichment Toys
Puzzles
Other

We want to learn about your dog's reactivity.

All about triggers and reactions.

Tell us what typically happens when your dog reacts.

About how close can your dog usually be to the thing they're reacting to before they begin to struggle? *

Across a large open area
Across the street
About 20–30 feet away
About 10–20 feet away
Less than 10 feet away
Distance doesn't seem to matter
I'm not sure
It depends

Once the thing your dog is reacting to is farther away or gone, how quickly does your dog usually settle? *

Within a minute or two
Within several minutes
It can take quite a while
My dog often remains upset or on alert afterward
I'm not sure
It varies

When your dog notices something that normally causes a reaction, are you sometimes able to get their attention before they react? *

Yes, usually
Sometimes
Rarely
No
I'm not sure

Has your dog ever snapped at or attempted to bite a person? *

Has your dog ever bitten a person and made contact with their skin? *

No
Yes, without breaking the skin
Yes, breaking the skin
Yes, causing an injury that required medical attention

If you answered Yes to the question above please tell us what happened.

Has your dog ever bitten or injured another dog or animal? *

If you answered Yes to the question above please tell us what happened.

Managing Your Dog

When your dog reacts on leash, are you physically able to maintain control of your dog? *

Yes
Usually
Sometimes I struggle
No
I'm not sure

If you sometimes struggle or are unable to maintain control, please tell us more.

Has your dog ever pulled the leash out of your hand, pulled you to the ground, or otherwise gotten away from you during a reaction? *

What equipment do you currently use when walking your dog around their triggers? (Select all that apply.) *

Other

Training History

Have you worked with a trainer or behavior professional about your dog’s reactions? *

What do you currently do when your dog begins to react? *

If this class could make one thing easier for you and your dog, what would you that be? *

How can the Safe For Life program help?

Please let us know what you are interested in: *

Nutrition Education & Resources
Enrichment Education - What is it and how can it help?
Learn more about Fear Free ways to train my dog
Group Classes (Focusing on topics like Basic training, Fitness, Reactive Resources)
Meet ups with like-minded pet parents (outings, socialization, and group walks)
Private training with a trusted positive reinforcement trainer in my area
URGENT HELP: I'm at my wits end with my dog!

Thanks for reaching out!

We appreciate you taking the time to complete our form. One of our team members will review your submission and be in touch in the next 48 business hours.

Have a great day and tell your dog we said "Hi!"

Safe For Life Foster Registration

Join our family