Akita's full name ______________________________ Callname ___________

Sex: Female Male Spay/Neuter: Yes No Date:__________________

Weight:_______ Age: ______ Age when obtained:_________________

Colors:_________________________________________________

Breeder:________________________________________________

AKC/CKC Registered: Yes No # ___________________ Birthdate ______________

Owner's Names:_______________________________________________________

Address:_____________________________________________________________

City/State/Zip_______________________________________________________

Owner's Home Phone ___________________ Work Phone ______________________

Housebroken: Yes No Sometimes Crate Trained: Yes No

Lead Trained: Yes No Obedience Trained: Yes No Some

Circle commands Akita adheres to: Sit Stay Come Down OK Break

Go Heel Off Heel Attack Other:________

Has Akita been shown: Yes No (circle) Obedience Confirmation

Ever had professional training for Akita: Yes No Who:___________

What type of training:____________________________________

Is Akita timid at Loud noises, such as: Vacuum - Firecrackers - Thunder -

Large Balloons - other:_________________________________

How does Akita act when visiting Vet:____________________

Have you ever boarded Akita: Yes No Where:______________________

How did Akita react to boarding:______________________________________

Describe Personality of Akita: (circle all that applies)

Energetic Loveable Smart Licker Talker Barker Playful Wrestles

Lazy Whiner Hides Nervous Shy Aloof Jumps up Pounces Stupid

Other:______________________________________

Is Akita friendly with: Men Women Children Babies Teens No one

Is Akita partial to one person: Yes No Who:_________________

How many people does the Akita come in contact with daily?________

How does Akita act on car rides: Loves it Enjoys Tolerates Hates

Does Akita go for walks: Yes No Sometimes How often:______

Does Akita ever run loose: Yes No When:____________

Has Akita ever run away: Yes No Explain:_________________________________

_________________________________________________________________________

How long was Akita gone:_____hours ______days______nights

What do you feed Akita?______________How much?_______________

How often?____________Does Akita leave food? Yes No Sometimes

What type of container does Akita eat from:_________________

Does Akita drink much water: Yes No Approximately_________

What type of container does Akita drink from:________________

Do you change water daily: Yes No More than once daily: Yes No

What treats do you feed:________________________How often:______________

Has Akita ever vomited: Yes No How often:_____________

Does Akita eat items (toys, etc.): Yes No What:__________________

How often does Akita play: A lot Often Occasionally Seldom Never

How does Akita Play: Running - Pounces - Jumps - Circles - Nipping

Other________________________________

What toys does Akita play with: Ball - Bones - Stuffed Toys - Tug Toys -

Plastic Bottles - Rope - Homemade Toys - Old Rags - Rugs - Doggy Toys -

What is special toy he likes best:__________________________

What does Akita do when company arrives: (circle all that applies)

Barks - Talks - Hides - Jumps up - Friendly - Never makes up - Pesky -

Dominates them - Remembers visitors and makes-up easily - Gets excited -

Takes time to get acquainted, then makes up - According to who it is -

Doesn't like strangers - Loves everyone, makes up fast

Do you hug Akita: Yes No Do you kiss Akita: Yes No

Do you spoil Akita: Yes No Do you pet Akita often: Yes No

Does Akita like to be scratched: Yes No Sometimes Often Always

Do you praise Akita often: Yes No What do you say:______________

How is Akita affectionate with you: Paws - kisses hand, face, arm feet,

nibbles, lies next to you, loves bites, sits on your lap, humps leg.

Is Akita affectionate with others: Yes No Who:______________

Do you have other pets: Yes No What:_______________________

How does Akita get along with them:_________________________

Does Akita and other pets stay together when you're not home: Yes No

Where does Akita stay when you're not home:___________________________

Where does Akita sleep: House Garage Yard Crate Pen Dog House

If in house, where:_____________________________________

Does Akita lie on back to sleep: Always Sometimes Seldom Never

Does Akita get on furniture: Yes No When invited Sometimes

Has Akita shown dominance with another dog: Yes No Who:____________

Has Akita been passive with another dog: Yes No Who:_________________

Has Akita ever had a dog fight: Yes No Explain________________

Were you present at above fight: Yes No Did you stop it: Yes No

Was Akita hurt in fight: Yes No How:____________________

Was other dog hurt in fight: Yes No How:________________

Was either dog taken to vet: Yes No Report Made: Yes No

What was the fight over:___________________________________

How do you discipline Akita:_________________________________

Do you hit Akita: Yes No What do you use:_____________________

Do you withdraw from Akita: Yes No When:____________________

How does Akita react to your withdrawal:__________________________

Does Akita pout: Yes No Over what:________________________

Does Akita ever run from you: Yes No How often:_______________

Would you say Akita is sensitive: A lot Often Sometimes Never

Does Akita like baths: Yes No Brushed: Yes No Sometimes

How often do you bathe Akita:_______________Brush:_________________________

Have you every had problems with Akita: Chewing - Digging - Barking

Running Away - Disobedient - Chasing - Unruly - Jumping Up - Jumping Fences - House-Training - Hiding Things - Gobbling Food - On Furniture - Gulping Water - Stealing - Jealousy - Selfish - Begging - Nipping

How does Akita act with children: Loving - scared - Aggressive - Cautious

How does Akita act with strangers: Friendly - Barks - Shy - Aggressive

Is Akita aggressive with: Women Men Children Strangers Dogs Cats

Has Akita ever bitten a human: Yes No Date:______________ Who:__________

How serious was the injury:_______________________________

Was it reported to Animal Control: Yes No Confinement: Yes No

Where and how long was the confinement:______________________________

Does Akita ever growl at you: Yes No At others: Yes No

Does Akita ever stare you down: Yes No At others: Yes No

Does Akita ever bare their teeth at you: Yes No At others: Yes No

Does Akita ever urinate when touched: Yes No When scolded: Yes No

Is Akita submissive to you: Yes No To others: Yes No

Does Akita crouch down at raised-hand: Yes No Raised Stick: Yes No

Is it possible any problems you have had with Akita may be due to your methods of training or inexperience: Yes No Please explain:________

_____________________________________________________________________________

Please read the following before you sign:
 
Please be aware that any falsification of this document may leave you open to the liability that will ensue if the Akita turns out to be people aggressive and you have NOT honestly answered the questions herein. Please be truthful as we will not turn you down EVEN IF AKITA IS AGGRESSIVE. We are trained to work with aggressive Akitas and can place the Akita in the home best suited for it. We will be better able to handle and retrain an Akita by knowing the truth.
 
I swear that all that I have stated above is correct and true to the best of my knowledge:
 
 
__________________________________Date:______________________
signature
 
 
Please note below ny specific information regarding the Akita that has not been covered in this document.