Name * First Name Last Name Phone Address Address 1 Address 2 City State/Province Zip/Postal Code Country People Authorized to pick up your dog: Pet Information Pets Name & Age First Name Last Name Neutered or Spayed? * Is your dog Neutered or Spayed? Breed & Gender If your dog is a mix, please list the 2 predominant breeds in behavior Color? Weight? Veterinary/Emergency Information Vet Hospital & Preferred Vet Any Health Issues: Any Allergies: Emergency Contact Your emergency contact is authorized to make emergency care decisions. They will take custody of your pet(s) if any unforeseen circumstances occur which prevent you from reuniting with your pet(s). Name: Phone: Name: Phone: Pet Information Off Leash Play We LOVE dogs and want your dog to love coming to our off-leash playgroup! No one knows your dog better than your, so we’d appreciate you taking the team to fill out our application. The more we know about the dogs in our care, the better our playgroups will be. How long have you owned your dog? * Anything more you'd like use to know? Where did you get your dog? Which of the following best describes your dog's level of socialization with other dogs: Has your dog had any issues previously in an off-leash social environment? Yes; Altercation or fight at a public park Yes; Altercation or fight with a friend's/neighbor's dog Yes; Fearful reaction in a group of dogs Dismissed from a prior dog daycare or social playgroup program Other, please describe Please explain other situation here: Health Information Does your dog have any allergies? * Does your dog have any physical disabilities? Does your dog have any medical conditions? Does your dog have any sensitive areas on his/her body? Select the answer below that best represents your dog's overall level of exercise routine: Couch potato - spends days sleeping, occasional walks and/or playtime with humans or other dogs Mild exerciser - short daily walks and/or regular playtime with humans or other dogs Moderate exerciser - long or multiple walks daily and/or regular playtime with humans or dogs Athlete - regular jogs/runs and/or regular participation in a dog sport activities such as agility, flyball, etc... Household Information How does your dog get along with other household animals? Does your dog like children? Do any visitors bring their dog(s) to your house? Are there any types and/or breeds of dogs your dog seems to automatically fear or dislike? How does your dog react to puppies? How does your dog react to another dog approaching him/her in a park, or on a walk? What kinds of games does your dog play with other dogs? Which commands does your dog know? Check all that apply Sit Stay Down Come Heel Rollover High Five How did your dog get his/her obedience training? Mark all that apply Attended one group class Attended more than one level of group classes Dog was sent to a board and train program Private sessions at home Other Does your dog have any problems in any of the following areas? If yes, please explain. Jumping on people, mouthing; house training; barking; digging; ignoring commands: Does your dog know any tricks? Dog Behavior Information Are there any particular types of people your dog seems to automatically fear or dislike? Has your dog ever growled at someone? Yes? No? If yes, what were the circumstances and how did you respond? Has your dog ever bitten a person? Yes? No? If yes, what were the circumstances and how did you respond? Please describe injuries (if any) Has your dog ever bitten another animal? Yes? No? If yes, what were the circumstances and how did you respond? Please describe injuries (if any) To the best of your knowledge, what does your dog do when you're not home? Has your dog ever climbed/jumped a fence? Yes? No? If yes, what were the circumstances and how high was the fence? Has your dog ever escaped from your house or yard? Yes? No? If yes, what were the circumstances? How would you describe the energy level of your dog? Low, Medium or High Is your dog frightened by thunderstorms? Yes? No? If yes, please explain: Is your dog frightened or nervous around anything else? Yes? No? If yes, please explain: Has your dog ever growled or snapped at a person and/or dog that have taken food or toys away from him/her? Yes? No? If yes, what were the circumstances and how did you respond? Other comments or information about your dog that you feel might be helpful? Thank you for taking the time to spend completing the application form. Please contact us if you have any questions on the next steps. Thank you for completing our form! We can't wait to meet your furry friend! our message has been received, and we're grateful for your interest. For bookings, please give us a call at 979.479.8322. We eagerly anticipate speaking with you soon!
