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Pender Pet Retreat Reservations
703-591-3304
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
Comments
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