Training Survey

Survey for Training and Socialization Programs

Owner Name:*
First Last
Phone Number:*
Email:*
Address*
ZIP / Postal Code
Preferred Communication Method:
- Email
- Phone- Call
- Phone- Text
How did you hear about us?
- Referred by Rescue Organization/ Shelter
- Referred by a Friend
- Referred by a Veterinarian
- Internet Search
- Facebook/ Instagram/ Youtube/ Other Social Media
Who may we thank for your referral?
Number of Adults in the Household
Number of Children in the Household
First Child Age
Second Child Age
Third Child Age
Fourth Child Age
Fifth Child Age
Tell us about your dog(s)! Please be honest. There are no right or wrong answers. There is no judgement here. Please be detailed in your responses. If you haven’t brought your puppy home yet, answer what you can.
How many dogs in the home?
How many dogs are we training?*
- 1
- 2
- 3
Dog's Name:
First Dog's Name:
Second Dog's Name:
Third Dog's Name:
Dog's Life Stage*
- Younger than 9 months
- Older than 9 months
Dog's Age:*
First Dog's Life Stage:*
- Younger than 9 months
- Older than 9 months
First Dog's Age:*
Second Dog's Life Stage:*
- Younger than 9 months
- Older than 9 months
Second Dog's Age:*
Third Dog's Life Stage*
- Younger than 9 months
- Older than 9 months
Third Dog's Age:*
Dog's Breed:
First Dog's Breed:
Second Dog's Breed:
Third Dog's Breed:
How long have you had the dog?
How long have you had the first dog?
How long have you had the second dog?
How long have you had the third dog?
I am interested in:
- Day Train at Chucktown Charley
- Board and Train at Chucktown Charley
- Dog Socialization Program
- All of the Above
I am interested in:
- Day Train at Chucktown Charley
- Board and Train at Chucktown Charley
- All of the Above
How did you obtain your dog?
- Breeder
- Rescue/ Shelter
- From a Friend
How did you obtain your first dog?
- Breeder
- Rescue/ Shelter
- From a Friend
How did you obtain your second dog?
- Breeder
- Rescue/ Shelter
- From a Friend
How did you obtain your third dog?
- Breeder
- Rescue/ Shelter
- From a Friend
Which one?
How old was the dog when you got the dog?
How old was the first dog when you got the first dog?
How old was the second dog when you got the second dog?
How old was the third dog when you got the third dog?
How old was the dog when he/she left the litter?
How old was the first dog when he/she left the litter?
How old was the second dog when he/she left the litter?
How old was the third dog when he/she left the litter?
How did you select your particular puppy?
- Breeder Selected
- Breeder temperament test- puppy suited my needs
- Looks
- Smallest
- Biggest
- Most outgoing
- Most quiet/ calm
- Most timid
- Most affectionate
- Only pup left from the litter
- Other
- N/A Acquired dog as an adult
If you got your dog as a puppy (younger than 6 months), how did you select that particular puppy?
- Breeder Selected
- Breeder temperament test- puppy suited my needs
- Looks
- Smallest
- Biggest
- Most outgoing
- Most quiet/ calm
- Most timid
- Most affectionate
- Only pup left from the litter
- Other
- N/A Acquired dog as an adult
If you got your first dog as a puppy (younger than 6 months), how did you select that particular puppy?
- Breeder Selected
- Breeder temperament test- puppy suited my needs
- Looks
- Smallest
- Biggest
- Most outgoing
- Most quiet/ calm
- Most timid
- Most affectionate
- Only pup left from the litter
- Other
- N/A Acquired dog as an adult
If you got your second dog as a puppy (younger than 6 months), how did you select that particular puppy?
- Breeder Selected
- Breeder temperament test- puppy suited my needs
- Looks
- Smallest
- Biggest
- Most outgoing
- Most quiet/ calm
- Most timid
- Most affectionate
- Only pup left from the litter
- Other
- N/A Acquired dog as an adult
If you got your third dog as a puppy (younger than 6 months), how did you select that particular puppy?
- Breeder Selected
- Breeder temperament test- puppy suited my needs
- Looks
- Smallest
- Biggest
- Most outgoing
- Most quiet/ calm
- Most timid
- Most affectionate
- Only pup left from the litter
- Other
- N/A Acquired dog as an adult
How did you select your first puppy?
- Breeder Selected
- Breeder temperament test- puppy suited my needs
- Looks
- Smallest
- Biggest
- Most outgoing
- Most quiet/ calm
- Most timid
- Most affectionate
- Only pup left from the litter
- Other
- N/A Acquired dog as an adult
How did you select your second puppy?
- Breeder Selected
- Breeder temperament test- puppy suited my needs
- Looks
- Smallest
- Biggest
- Most outgoing
- Most quiet/ calm
- Most timid
- Most affectionate
- Only pup left from the litter
- Other
- N/A Acquired dog as an adult
How did you select your third puppy?
- Breeder Selected
- Breeder temperament test- puppy suited my needs
- Looks
- Smallest
- Biggest
- Most outgoing
- Most quiet/ calm
- Most timid
- Most affectionate
- Only pup left from the litter
- Other
- N/A Acquired dog as an adult
What is the reason you chose to get a dog?
Veterinarian's Name
Veterinarian's Phone
Is your dog
- Male
- Female
- Spayed Female
- Neutered Male
Is your first dog
- Male
- Female
- Spayed Female
- Neutered Male
Is your second dog
- Male
- Female
- Spayed Female
- Neutered Male
Is your third dog
- Male
- Female
- Spayed Female
- Neutered Male
Are there any medical issues for the dog that you are aware of? Any food allergies?
Are there any medical issues for the first dog that you are aware of? Any food allergies?
Are there any medical issues for the second dog that you are aware of? Any food allergies?
Are there any medical issues for the third dog that you are aware of? Any food allergies?
What brand AND amount of food are you feeding your dog per day? How many times per day?
What brand AND amount of food are you feeding your first dog per day? How many times per day?
What brand AND amount of food are you feeding your second dog per day? How many times per day?
What brand AND amount of food are you feeding your third dog per day? How many times per day?
How is the dog fed? Free-fed, fed on a schedule, in crates, etc.
How are the dogs fed? Free-fed, fed on a schedule, in crates, etc.
Where do the dogs sleep at night?
- Crated
- Outside Pen
- Human's Bed
- Garage
Where does the dog sleep at night?
- Crated
- Outside Pen
- Human's Bed
- Garage
How much sleep does your dog currently get per day?
Where is the dog kept when left alone?
Where are the dogs kept when left alone?
Is the dog crate trained?*
- Yes
- No
Please describe in detail how your dog(s) reacted in the crate.*
Has your dog or have your dogs ever harmed themselves a crate?*
- Yes
- No
Please explain.*
Is the first dog crate trained?*
- Yes
- No
Is the second dog crate trained?*
- Yes
- No
Is the third dog crate trained?*
- Yes
- No
If your dogs are not crate trained, are you interested in crate training?*
- Yes
- No
If your dog is not crate trained, are you interested in crate training?*
- Yes
- No
What is or will be the dog's primary form of exercise?
What are or will be the dogs' primary form of exercise?
How much exercise does the dog currently get?
How much exercise do the dogs currently get?
How consistent is this exercise?
What is your living situation?
- House
- Apartment/Condo
Do you have a fenced in yard?
- Yes
- No
Do you plan on leaving your dog(s) unattended in your backyard?
- Yes
- No
Have you done any previous training on your own? Be as specific as you can (methods used, level of success, etc.).
Have you done any previous training with another trainer (even if it was with another dog)? Be as specific as you can (type of training, level of success, what you liked, what you did not like, etc.).
Does the dog attend daycare or boarding at a facility?
- Daycare or Boarding at Chucktown Charley
- Daycare or Boarding at Another Facility
- Does not attend daycare or boarding
Do the dogs attend daycare or boarding at a facility?
- Daycare or Boarding at Chucktown Charley
- Daycare or Boarding at Another Facility
- Does not attend daycare or boarding
Which one?
Has the dog had any socialization or exposure to people, other dogs, or both? If so, where?
Have the dogs had any socialization or exposure to people, other dogs, or both? If so, where?
How often is the dog taken for a walk?
How often is the first dog taken for a walk?
How often is the second dog taken for a walk?
How often is the third dog taken for a walk?
Does the dog pull on the leash?
- Yes. All the time.
- Sometimes.
- No. Walks nicely on the leash.
- Dog is not walked.
Does the first dog pull on the leash?
- Yes. All the time.
- Sometimes.
- No. Walks nicely on the leash.
- Dog is not walked.
Does the second dog pull on the leash?
- Yes. All the time.
- Sometimes.
- No. Walks nicely on the leash.
- Dog is not walked.
Does the third dog pull on the leash?
- Yes. All the time.
- Sometimes.
- No. Walks nicely on the leash.
- Dog is not walked.
Dog is walked using:
- Flat collar
- Off leash
- Retractable leash
- Harness
- Headcollar
- Slip collar/ choke chain
- Prong collar
- E-collar
- Dog is not walked
- Other
First Dog is walked using:
- Flat collar
- Off leash
- Retractable leash
- Harness
- Headcollar
- Slip collar/ choke chain
- Prong collar
- E-collar
- Dog is not walked
- Other
Second Dog is walked using:
- Flat collar
- Off leash
- Retractable leash
- Harness
- Headcollar
- Slip collar/ choke chain
- Prong collar
- E-collar
- Dog is not walked
- Other
Third Dog is walked using:
- Flat collar
- Off leash
- Retractable leash
- Harness
- Headcollar
- Slip collar/ choke chain
- Prong collar
- E-collar
- Dog is not walked
- Other
Please specify
What physical limitations do you have that I should be aware of (i.e. difficulty bending, holding a leash, maintaining balance)?
How does your puppy react to sudden noises?
How do your puppies react to sudden noises?
Does your puppy or do your puppies enjoy playing with toys?
How often does your puppy play bite?
- Does not display this behavior
- Infrequently
- All the time
How often does your first puppy play bite?
- Does not display this behavior
- Infrequently
- All the time
How often does your second puppy play bite?
- Does not display this behavior
- Infrequently
- All the time
How often does your third puppy play bite?
- Does not display this behavior
- Infrequently
- All the time
If your puppy is pottying in the house, how often does it happen?
- Does not potty in the house
- Infrequently (less than 3 times a week)
- Occasionally (3-5 times a week)
- Almost every day
- Daily
- Several times per day
If your first puppy is pottying in the house, how often does it happen?
- Does not potty in the house
- Infrequently (less than 3 times a week)
- Occasionally (3-5 times a week)
- Almost every day
- Daily
- Several times per day
If your second puppy is pottying in the house, how often does it happen?
- Does not potty in the house
- Infrequently (less than 3 times a week)
- Occasionally (3-5 times a week)
- Almost every day
- Daily
- Several times a day
If your third puppy is pottying in the house, how often does it happen?
- Does not potty in the house
- Infrequently (less than 3 times a week)
- Occasionally (3-5 times a week)
- Almost every day
- Daily
- Several times a day
Has your puppy exhibited any growling, lip snarling, stiffening behaviors? If so, please explain in detail.
Have your puppies exhibited any growling, lip snarling, stiffening behaviors? If so, please explain in detail.
Describe in detail how your dog reacts to the site of another animal when they are on leash.
Describe in detail how your first dog reacts to the site of another animal when they are on leash.
Describe in detail how your second dog reacts to the site of another animal when they are on leash.
Describe in detail how your third dog reacts to the site of another animal when they are on leash.
Describe in detail how your dog reacts to the site of another human when they are on leash.
Describe in detail how your first dog reacts to the site of another human when they are on leash.
Describe in detail how your second dog reacts to the site of another human when they are on leash.
Describe in detail how your third dog reacts to the site of another human when they are on leash.
Describe in detail how your dog reacts to the site of another animal when they are off leash.
Describe in detail how your first dog reacts to the site of another animal when they are off leash.
Describe in detail how your second dog reacts to the site of another animal when they are off leash.
Describe in detail how your third dog reacts to the site of another animal when they are off leash.
Describe in detail how your dog reacts to the site of another human when they are off leash.
Describe in detail how your first dog reacts to the site of another human when they are off leash.
Describe in detail how your second dog reacts to the site of another human when they are off leash.
Describe in detail how your third dog reacts to the site of another human when they are off leash.
Has your dog ever gotten into a dog fight or bitten a person?
- Has not bitten
- Has bitten another dog
- Has been in a full- on dog fight
- Has nipped a person- no broken skin
- Has bitten a person- broken skin
Has your first dog ever gotten into a dog fight or bitten a person?
- Has not bitten
- Has bitten another dog
- Has been in a full- on dog fight
- Has nipped a person- no broken skin
- Has bitten a person- broken skin
Has your second dog ever gotten into a dog fight or bitten a person?
- Has not bitten
- Has bitten another dog
- Has been in a full- on dog fight
- Has nipped a person- no broken skin
- Has bitten a person- broken skin
Has your third dog ever gotten into a dog fight or bitten a person?
- Has not bitten
- Has bitten another dog
- Has been in a full- on dog fight
- Has nipped a person- no broken skin
- Has bitten a person- broken skin
In the last 3 months, how many times has the dog threatened to bite a human (air snaps, growling, lifted lip) but has not made skin contact?
- Has not threatened to bite or shown any of the listed behaviors
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the first dog threatened to bite a human (air snaps, growling, lifted lip) but has not made skin contact?
- Has not threatened to bite or shown any of the listed behaviors
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the second dog threatened to bite a human (air snaps, growling, lifted lip) but has not made skin contact?
- Has not threatened to bite or shown any of the listed behaviors
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the third dog threatened to bite a human (air snaps, growling, lifted lip) but has not made skin contact?
- Has not threatened to bite or shown any of the listed behaviors
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the dog “nipped”- made human skin contact with teeth but did no damage?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the first dog “nipped”- made human skin contact with teeth but did no damage?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the second dog “nipped”- made human skin contact with teeth but did no damage?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the third dog “nipped”- made human skin contact with teeth but did no damage?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the dog made contact with human skin and did minor damage (1-4 punctures, dog did not hold on)?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the first dog made contact with human skin and did minor damage (1-4 punctures, dog did not hold on)?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the second dog made contact with human skin and did minor damage (1-4 punctures, dog did not hold on)?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the third dog made contact with human skin and did minor damage (1-4 punctures, dog did not hold on)?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the dog bitten a human and caused deep punctures, bruising, or damage caused by holding onto the bite?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the first dog bitten a human and caused deep punctures, bruising, or damage caused by holding onto the bite?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the second dog bitten a human and caused deep punctures, bruising, or damage caused by holding onto the bite?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
In the last 3 months, how many times has the third dog bitten a human and caused deep punctures, bruising, or damage caused by holding onto the bite?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
As far as you know, how many times in its life has the dog bitten and caused serious damage to a human- multiple bites in one incident, and/or grabbing and shaking- that required immediate medical attention?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
As far as you know, how many times in its life has the first dog bitten and caused serious damage to a human- multiple bites in one incident, and/or grabbing and shaking- that required immediate medical attention?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
As far as you know, how many times in its life has the second dog bitten and caused serious damage to a human- multiple bites in one incident, and/or grabbing and shaking- that required immediate medical attention?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
As far as you know, how many times in its life has the third dog bitten and caused serious damage to a human- multiple bites in one incident, and/or grabbing and shaking- that required immediate medical attention?
- Has not nipped
- 1-3 times
- 4-6 times
- 7-10 times
- Very frequently (more than 10 times)
Has the dog ever injured another animal? Please specify.
Has the first dog ever injured another animal? Please specify.
Has the second dog ever injured another animal? Please specify.
Has the third dog ever injured another animal? Please specify.
Goals & Priorities
What do you consider to be the #1 PROBLEM that you’re struggling with?
What do you consider to be the #2 PROBLEM that you’re struggling with?
What do you consider to be the #3 PROBLEM that you’re struggling with?
What is your #1 GOAL with this dog?
What is your #1 GOAL with your dogs?
Thank you for taking the time to fill out our survey. Please understand that not every situation is the right fit for our programs or schedule. We will be in touch with you to let you know the next steps.

Useful Pages

843.559.0680

Survey for Training and Socialization Programs

Tell us about your dog(s)! Please be honest. There are no right or wrong answers. There is no judgement here. Please be detailed in your responses. If you haven’t brought your puppy home yet, answer what you can.

Goals & Priorities

Thank you for taking the time to fill out our survey. Please understand that not every situation is the right fit for our programs or schedule. We will be in touch with you to let you know the next steps.

Useful Pages

Our Dog Training Partner

Pick Up and Drop Off Hours