Dog Day Care Application

Please fill out all the fields and hit the submit button.
You will be contacted by Heather.
Thank you.

Owner Information
Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
E-mail:

General
Dog's Name:
Breed:
Date Aquired Dog:
Sex:
Age:
Is dog spayed/Neutered:
Age Spayed/Neutered:
Where did you get dog:
Knowledge of dog's history:

Behavioral Information
Do you have children?
If yes, what are their ages and sex?
Does your dog like children?
How does your dog behave around children?
Are there other animals in your home?
If yes, what type, sex and age of each:
How does your dog get along with other resident animals?
Has your dog been around other dogs?
How did your dog respond?
Is your dog afraid of any specific items/noises?
If yes, what?
How does your dog respond to strangers in your yard/home?
How does your dog respond to strangers in an unknown location?
Does your dog ever bark or growl at people passing outside your home or yard?
Are there any kinds of people your dog automatically fears or dislikes?
If yes, please explain:
How does your dog respond to new dogs?
How does your dog respond to puppies?
Where is your dog kept when you are not home?
Is your dog destructive in your house?
Does your dog show any signs of anxiety when you leave?
If yes, what are the signs?
How does your dog act when you get home?
How much regular, structured exercise does your dog get?
Has your dog ever growled or snapped at anyone?
If yes, how many times and please describe each
Has your dog ever bitten anyone?
If yes, how many times?
Was the skin broken?
Please explain the circumstances
Does your dog have a tendency toward any of the following behaviors? If yes, please explain:
Mouthing:
House soiling:
Barking:
Digging:
Jumping
Has your dog ever growled or snapped at anyone who has taken food or toys away?
If yes, please explain:
How does your dog respond if another animal approaches your dog's food or toys?
Does your dog play with toys?
If yes, what are his/her favorite kinds?
What are your dog's favorite games?
Does your dog play with other dogs?
If yes, how often and with what breeds of dogs?

Health and Grooming
Does your dog have a problem with fleas?
If yes, how are you treating them?
Does your dog have any known physical problems?
If yes, what kind?
Are there any restrictions that need to be placed on your dog's physical activities or movements?
If yes, what restrictions?
Does your dog have allergies?
If yes, how are you treating them?
Does your dog like to be brushed?
How does your dog react to having his/her toe nails clipped?
Has your dog ever growled or snapped while having his/her nails trimmed?
Can you touch all parts of your dog's body?
Can other people touch all parts of your dog's body?
Has your dog ever growled or snapped at you or any other person while being touched?
If yes, please describe:
What are your dog's favorite petting spots?

Training
Has your dog ever had any formal obedience training?
If yes, when and where?
What obedience commands and/or tricks does your dog know?
How responsive is you dog to commands?
Does your dog know a bathroom command?
If yes, what is it?

Any other info about your dog: