Daycare Application

Off-Leash Daycare Application

Interested in signing your dog up for off-leash daycare? Fill out the form below and click "Submit", and we will get in touch with you shortly to set up your pet's evaluation!

Dog Information
Owner Name*
First Last
Cell Phone (Primary Phone)*
Contact Email*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Who is your pet's regular veterinarian?*
Dog's Name*
Is your dog:*
- Male
- Female
When is your dog's approximate date of birth?*
MM slash DD slash YYYY
Dog's Breed (If a mix, please list 2 predominant breeds)*
Is your dog spayed or neutered?*
- Yes
- No
In what weight range does your dog fall?*
- Less than 10 lbs.
- 10-30 lbs.
- 30-60 lbs.
- 60-100 lbs.
- Over 100 lbs.
Where did you get your dog?*
- Animal Shelter
- Animal Rescue Group
- Breeder
- Pet Store
- Friend
- Found as Stray
How long have you owned your dog?*
Why are you considering our off-leash play program for your dog? (Select all that apply)*
- To play with other dogs.
- So he/she isn't home alone.
- Separation anxiety.
- Exercise.
- Recommended by a friend.
- Recommended by a pet professional (vet, trainer, etc.)
- Other
Why are you considering our off-leash play program for your dog? (Explain other reason.)*
Which of the following BEST describes your dog's level of socialization with other dogs?*
- None - no knowledge of other dog interaction
- Minimal - on-leash encounters only
- Moderate - some off-leash playtime on occasion
- Extensive - regular visits to dog social events, off-leash dog parks, dog daycare, etc.
Has your dog had any problems previously in an off-leash social environment?*
- Yes
- No
Please explain any problems:*
Has your dog been dismissed from a prior group program?*
- Yes
- No
What reason were you given for the dismissal?*
Health History
What product do you use for flea/tick control?*
Has your dog received his/her flea/tick preventative in the last 30 days?*
- Yes
- No
Does your dog have any allergies?*
- Yes
- No
Please explain your dog's known allergies:*
Does your dog have any physical disabilities?*
- Yes
- No
Please explain your dog's physical disabilities:*
Does your dog have any medical conditions?*
- Yes
- No
Please explain your dog's medical condition(s):*
Does your dog have any bathroom-related issues or concerns?*
- Yes
- No
Please explain bathroom-related concerns:*
Check the box that BEST represents your dog's overall level of exercise:*
- Couch Potato: spends all day sleeping, occasional walks and/or playtime
- Mild Exerciser: short daily walks and/or regular playtime
- Moderate Exerciser: long or multiple walks daily and/or regular playtime
- Athlete: regular jogs/runs and/or regular participation in a dog sport activity such as agility, flyball, frisbee, etc.
Behavior
How does your dog react to children?*
- Positive Reaction.
- Indifference.
- Negative Reaction.
- Mixed Reaction.
- Not Applicable.
How does your dog react to other animals living in the household?*
- Positive Reaction.
- Indifference.
- Negative Reaction.
- Mixed Reaction.
- Not Applicable.
How does your dog react to visitors bringing their animals into the household?*
- Positive Reaction.
- Indifference.
- Negative Reaction.
- Mixed Reaction.
- Not Applicable.
How does your dog react to strangers?*
- Positive Reaction.
- Indifference.
- Negative Reaction.
- Mixed Reaction.
- Not Applicable.
How does your dog react to puppies?*
- Positive Reaction.
- Indifference.
- Negative Reaction.
- Mixed Reaction.
- Not Applicable.
How does your dog react to others approaching them while ON leash?*
- Positive Reaction.
- Indifference.
- Negative Reaction.
- Mixed Reaction.
- Not Applicable.
How does your dog react to others approaching them while OFF leash?*
- Positive Reaction.
- Indifference.
- Negative Reaction.
- Mixed Reaction.
- Not Applicable.
Does your dog ever growl or bark at anyone passing outside your home or yard?*
- Yes
- No
Does your dog play with other dogs?*
- Yes
- No
Please describe other dogs (sizes, breeds, sex, temperaments, etc.):*
Is your dog willing to share his/her food or toys with other animals?*
- Yes
- No
Please select all commands your dog knows:*
- Sit.
- Stay.
- Wait.
- Down.
- Off.
- Come.
- Heel.
What type of collar/harness do you use to secure your dog?*
- Buckle collar.
- Nylon choke collar.
- Chain choke collar.
- Head collar.
- Prong/Pinch collar.
- Harness - leash clips on back.
- Harness - leash clips on front.
Does your dog have a tendency to jump up on people?*
- Yes
- No
Check any of the following areas where your dog may have behavioral problems:*
- Mouthing
- Housetraining
- Barking
- Digging
- Jumping
- Ignoring Commands
- Other
Describe other behavioral problem(s):*
Are there any particular types of people your dog seems to automatically fear or dislike?*
Has your dog ever growled at someone?*
- Yes
- No
Please explain growling situation:*
Has your dog ever bitten someone?*
- Yes
- No
Please explain human biting situation:*
Has your dog ever bitten another animal?*
- Yes
- No
Please explain animal biting situation:*
Has your dog ever escaped from your yard or residence?*
- Yes
- No
Please explain escape situation:*
Is your dog frightened by thunderstorms?*
- Yes
- No
Is your dog frightened or nervous around anything else?*
Does your dog seem to enjoy playing with toys?*
- Yes
- No
Describe your dogs favorite toys to play with:*
Does your dog get protective around his/her toys?*
- Yes
- No
Comments or other information you feel may be helpful:
By adding my Electronic Signature and the date below, I certify that the information which I have provided on this form is true, accurate, and complete.
Electronic Signature Date
Email
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