"*" indicates required fields Day Camp (Off-Leash Play) ApplicationWe love dogs and want your dog to love coming to our off-leash playgroup. No one knows your dog better than you, so we’d appreciate you taking the time to fill out this application. The more we know about the dogs in our care, the better our playgroups will be. Owner's Name* First Last Today's Date* MM slash DD slash YYYY Phone*Email Dog InformationPlease submit one application for each dog who you would like to have in off-leash playDog's Name* Breed* If a mix, list two predominant breeds in behavior Current age* How long have you owned your dog?*YearsMonthsDo we have vaccine history on file from your veterinarian?* Yes No If no, we are happy to contact your veterinarian:*NameCityPlease describe your dog’s flea/tick control and prevention program:* None Prescription Non-Prescription How often?* Summer months All year If prescription:* Oral chew 9 (Simparica, Bravecto, Nextgard, etc.) Topical (Frontline, Advantix multi, Revolution, etc.) If non-prescription:* Topical (Advantix II, Hartz, etc.) Flea collar Other Does your pet take heartworm preventative?* Yes No How often?* Summer months All year Does your dog have any allergies?* Yes No If yes, please explain* Does your dog have any physical disabilities?* Yes No If yes, please explain disability and cause* If answered yes, what restrictions need to be placed on your dog’s activities or movements?* No jumping No running No hard play No contact with other dogs Other If other, please explain*Does your dog have any medical conditions?* Yes No If yes, please explain* If medication is used to control the condition, please provide name(s) and dosageMedication NameDosage Add RemoveProvide details of your dog’s dieta. type (kibble, canned, raw/freeze dried, etc)* b. brand (Iams, Purina, etc.)* c. feeding amount and schedule* d. Any diet restrictions* e. Can we give your dog treats?* Yes No f. Any treat restrictions* On what type of surface does your dog generally go to the bathroom (e.g., grass, mulch, rocks, pee pads)?* Does your dog have any bathroom-related issues or concerns?* How often do you brush or comb your dog’s coat?* How does your dog react to having his/her nails clipped?* Does your dog like to be brushed?* Yes No If no, what have you tried to make it more enjoyable?* Does your dog have any sensitive areas on his/her body?* Yes No If yes, where?* Where are your dog’s favorite petting spots? Why are you considering our off-leash dog play program for your dog? (check all that apply) Play with other dogs So not home alone Exercise Recommended by other pet professional (trainer, vet, etc.) Other So not home alone; check if exhibits symptoms of separation anxiety Exercise* Primary source Additional source of exercise Reason* If other, please explain* Which of the following best describes your dog’s level socialization with other dogs:* None – No knowledge of other dog interaction Minimal – On leash encounters only Moderate – Some off-leash playtime on occasion with visitor’s/neighbor’s/friend’s dog(s) Extensive – Regular visits to dog social events, off-leash dog parks, dog daycare, etc. How does your dog react when seeing other dogs?* Ignores other dogs Happy to see other dogs and Scared when seeing other dogs Reactive towards other dogs by Other If happy, my dog* Does not try to engage them Wants to engage playfully with them If scared, my dog* Does not try to engage them Attempts friendly engagement If reactive, my dog* Vocalizing (barks, growls, snarls) only Vocalizing and ... Vocalizes and* Tries to move away from other dogs Lunges at other dogs Has your dog had any problems previously in an off-leash social environment?* Yes No If yes check all that apply:* Altercation or fight at a public dog park Altercation or fight with a neighbor or friend’s dog Fearful reaction in a group of dogs (tail tucked, trying to flee, submissive urination) Dismissed from a prior dog daycare or social playgroup program, reason dismissed: Other Check each below that applies to the situation resulting in your dismissal.* My dog was injured, no medical treatment required My dog was injured and required medical treatment Another dog was injured, no medical treatment required Another dog was injured and required medical treatment A person was injured, no medical treatment required A person injured and required medical treatment Provide any other comments you want us to know about this situation* If other, please describe* How frequently is your dog walked outside?* Rarely 1-3 times per week 4-7 times per week Multiple daily Other How long are your walks?* <30 min 30-60 min >60 min Other Check the box 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 human or other dogs. Moderate Exerciser: Long or multiple walks daily and/or regular playtime with human or dogs. Athlete: Regular jogs/runs and/or regular participation in a dog sport activity such as agility, flyball, or Frisbee, etc. Complete the following table with information on other pets in household:BreedAgeSexSpayed/Neutered Add RemoveDo you have cats?* Yes No If yes, how does your dog get along with your cats?* How does he react to unfamiliar cats he sees on walks?* Has your dog ever chased or tried to chase a small animal?* Yes No If yes, what were the circumstances?* Has your dog ever chased someone (or wanted to) on a skateboard or bicycle?* Yes No If yes, what were the circumstances? Does your dog like children?* Yes No How does your dog behave around children? How does your dog get along with other household animals? Do any visitors bring their dog(s) to your house?* Yes No If yes, how do they get along?* How does your dog react to a stranger coming into your home or yard?* Does your dog ever bark or growl at anyone passing outside your home or yard?* Yes No If yes, please explain* Are there any types, sizes, and/or breeds of dogs your dog seems to automatically fear or dislike?* Yes No If yes, please describe* How does your dog react to puppies? How does your dog react to a person approaching him/her in a park, or on a walk? On LeashHow does your dog react to a person approaching him/her in a park, or on a walk? Off LeashWhat kinds of games does your dog play with people? How does your dog react to family members approaching his/her food or toy? How does your dog react to non-family people approaching his/her food or toy? Does your dog play with other dogs?* Yes No If yes, which type?* Male and females Only females Only males Please describe size, breed, & temperament of the other dogs*SizeBreedTemperamentWhat kinds of games does your dog play with other dogs?* Has your dog ever shared his/her food or toys with other animals?* Yes No If yes, how does your dog react to another dog approaching his/her food or toy?* Which commands does your dog know? (please check all that apply) Sit Stay Down Come Heel Rollover Kisses High Five Spin Other If other, please explain* How did your dog get his/her obedience training? (Please check all that apply) Attended one group class Attended more than one level of group classes (beginner and intermediate, etc.) Dog was sent to a board and train program Private sessions in home Other If other, please explain* Which of the following best describes the use of obedience cues with your dog at home?* Key part of daily communication Used when we go on walks or have people over Used occasionally to better control behavior Rarely used What kind of a collar do you use to walk your dog?* Buckle Nylon/Chain Choke Collar Harness – Leash Clips on Back Harness – Front Clip Head Collar Prong/Pinch Other Is it effective in keeping him/her under control?* Yes No Has your dog ever gotten away from someone when out for a walk?* Yes No If yes, please explain circumstances* Where does your dog sleep?* Inside the house Outside the house Inside/Outside-varies In which room in the house does your dog sleep? Where in the room does your dog sleep? Crate Owner’s bed Dog Cushion/Bed on floor Other Has your dog ever jumped up on someone?* Yes No If yes, what were the circumstances?* How does your dog act when you get home at the end of the day?* What does your dog do to show he/she is happy?* What does your dog do to show he/she is upset? Is your dog allowed on the furniture at home?* Yes No Why? Does your dog have any problems in any of the following areas?* Mouthing Jumping/Pulling Housetraining Barking Digging Ignoring commands If yes, please explain* MouthingIf yes, please explain* Jumping/Pulling If yes, please explain* HousetrainingIf yes, please explain* BarkingIf yes, please explain* DiggingIf yes, please explain* Ignoring commandsAre 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 any injuries (if any) To the best of your knowledge, what does your dog do when you’re not at home? Has your dog ever climbed/jumped a fence?* Yes No If yes, what were the circumstances?* How high was the fence?* Has your dog ever escaped from your house or yard?* Yes No If yes, please explain the circumstances: How would you describe the energy level of your dog?* Low Medium High Is your dog frightened by thunderstorms?* Yes No If yes, describe typical behavior & what specifically helps to relax your dog or calm his/her fear.* Is it okay if we were to give your dog a natural calming supplement during Thunderstorms?* Yes No Is your dog frightened or nervous around anything else?* Yes No If yes, please explain.* Does your dog play with any toys?* Yes No If yes, what kinds of toys does your dog like?* Has your dog ever growled or snapped at a person who has taken food or toys away from him/her?* Yes No If yes, what were the circumstances and how did you respond?* Has your dog ever growled or snapped at another dog who has taken food or toys away from him/her?* Yes No If yes, what were the circumstances and how did you respond?* Have you ever noticed your dog stopping and staring at another animal?* Yes No If yes, what were the circumstances?* Other comments or information about your dog that you feel might be helpful? Thank you for the time you spent completing the application form. We look forward to meeting you and your dog on evaluation day. Please contact us if you have any questions on the next steps of the evaluation process. PhoneThis field is for validation purposes and should be left unchanged.
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