DAYCARE & BOARDING APPLICATION

DAYCARE & BOARDING APPLICATION 2018-04-11T18:35:43+00:00

DAYCARE & BOARDING APPLICATION

Owner's Name:

Address:

Phone:

Email:

Emergency Contact Information:

Emergency Contact #1
Name:
Phone:
Relation:

Emergency Contact #2
Name:
Phone:
Relation:

Others authorized to pick up my pet:

Veterinarian Information

Veterinary Clinic:

Clinic Address:

Clinic Phone:

Name of Veterinarian:

Dog's Name

Breed (If a mix, list 2 predominant breeds in behavior):

Birthdate:

Spay/Neuter Date (All dogs over six months of age must be spayed or neutered to attend our daycare/boarding programs):

Gender:

Weight:

Coloring:

Where did you get your dog?

Why are you considering Dogwood's Program?

Which of the following best describes your dog's level of socialization with other dogs:
None - no knowledge of other dog interactionMinimal - on-leash encounters onlyModerate - some off-leash playtime on occasion with visitor's/neighbor's/friend's dogExtensive - 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? YesNo

If Yes, check all that apply:
Altercation or fight at public dog parkAltercation or fight with a neighbor's or friend's dogFearful reaction in a group of dogsDismissed from a prior dog daycare or social playgroup programOther

If "Other" please describe:

Only complete if you answered yes above, that your dog was dismissed from a prior program:
What reason were you given as to why your dog was dismissed?

HEALTH HISTORY

Please describe your dog's flea/tick prevention program:

Does your dog have any allergies? YesNo

If Yes please describe:

Does your dog have any physical disabilities? YesNo

Please explain disability and cause, restrictions needed, medical conditions and/or meds:

Provide details of your dog's diet:

a. type (kibble, canned, raw/natural)
b. brand (Innova, Iams, Purina, etc.)
c. feeding schedule:

On what type of surface does your dog generally go to the bathroom (e.g. grass, mulch, pee pads)?

Does your dog have any bathroom related issues or concerns? YesNo

If yes, please explain:

How does your dog react to have his/her nails clipped?

Does your dog like to be brushed? YesNo

If no, what have you tried to make it more enjoyable?

Does your dog have any sensitive areas on his/her body? YesNo

If yes, where?

Where are your dog's favorite petting spots?

How frequently is your dog walked outside?

How long are your walks?

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 dogsMild Exerciser:Short daily walks and/or regular playtime with humans or other dogsModerate Exerciser: Long or multiple walks daily and regular playtime with humans or dogsAthlete: Regular jogs/runs and/or regular participation in a dog sport activity such as agility, flyball, frisbee, etc.

Do any visitors bring their dogs to your house? YesNo

If yes, how do they get along?

Are there any types and/or breeds of dogs your dog seems to automatically fear or dislike? YesNo

If yes, please explain

How does your dog react to puppies?

How does your dog react to another dog approaching him/her in a park, at the beach or on a walk?

On leash:

Off leash:

Does your dog play with other dogs? YesNo

If yes, Which type:

Males and females, only males, only females

Please describe size, breed and temperament of the other dogs:

Has your dog ever shared his/her food or toys with other animals? YesNo

If yes, how does your dog react to another dog approaching his/her food or toys?

Which commands does your dog know? (check all that apply)
SitStayDownComeHeelRolloverKissesHigh FiveOther

If "Other" please explain:

How did your dog get his/her obedience training? (check all that apply)
Attended one group classAttended more than one level of group classes (beginner, intermediate, etc)Dog was sent to a board and train programPrivate sessions in homeNo formal trainingOther

If "Other" please explain:

Which of the following best describes the use of obedience training cues with your dog at home? Key part of daily communicationUsed when we go on walks or have people overUsed occasionally to better control behaviorRarely usedNot applicable

What kind of collar do you use to walk your dog? BuckleNylon/Chain Choke CollarHarness leash clips on backHarness - leash clips on frontHead CollarProng/PinchOther

If "Other" please explain:

Is it effective keeping him/her under control? YesNo

Has your dog ever gotten away from someone when out for a walk? YesNo

If yes, please explain circumstances:

Where does your dog sleep? Inside the houseOutside the houseInside/Outside varies

In which room in the house does your dog sleep?

Where in the room does the dog sleep? CrateOwner's BedDog Cushion/Bed on FloorOther

If "Other" please explain:

What does your dog do to show he/she is happy?

What does your dog do to show he/she is upset?

Does your dog have any problems in the following areas?

Mouthing YesNo
House training YesNo
BarkingYesNo
Digging YesNo
Ignoring Commands YesNo

If yes, please explain.

DOG BEHAVIOR

Are there any types of people your dog seems to automatically fear or dislike? Explain

Has your dog ever growled at someone? If yes, what were the circumstances and how did you respond?

Has your dog ever bitten a person? YesNo

If yes, what were the circumstances and how did you respond?

Please describe any injuries.

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? YesNo

If yes, what were the circumstances? How high was the fence?

Has your dog ever escaped from your house or yard? YesNo

If yes, please explain the circumstances:

Has your dog ever chased or tried to chase a small animal? YesNo

If yes, what were the circumstances?

Is your dog frightened of thunderstorms? YesNo

If yes, describe typical behavior and what specifically helps relax your dog or calm his/her behavior?

Is your dog frightened or nervous around anything else? YesNo

If yes, please explain

Other comments or information about your dog you feel may be helpful: