Daycare Application

Daycare Application
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Number*

Area CodePhone Number
Cell Number*

Area CodePhone Number
Work Number

Area CodePhone Number
What veterinarian do you go to?*
Veterinarian’s phone number*

Area CodePhone Number
Is there someone else in the home we may contact if needed?*

YesNo
Secondary contact*

First NameLast Name
Secondary contact phone*

Area CodePhone Number
Emergency contact*

First NameLast Name
Emergency phone*

Area CodePhone Number
How many dogs are in need of daycare?*
please answer 1-4
Name of dog #1*
How long have you had dog #1*
Where did you get dog #1?*
Sex of dog #1*

MaleFemale
Is dog #1 spayed/neutered?*

YesNo
Is dog #1 a rescue?*
What is dog #1’s birthdate?*

MonthDayYear
Date
What is dog #1’s primary breed?*
What is dog #1’s primary color?*
What is dog #1’s weight in pounds?*
What is dog #1’s energy level?*

Very LowLowMediumHighVery High
Is dog #1 crate trained?*

YesNo
Does dog #1 like their crate?*

YesNo
Please select any attributes that accurately represent dog #1’s personality.*

PlayfulOutgoingShySubmissiveAffectionateInsecureGentleQuiteMouthyJumpyAvid BarkerExcitable
Please indicate any situations that may result in dog #1 becoming unfriendly or where they may react in a negative manner.*

Grabbing their collarHuggingBeing removed from furnitureBeing touched while sleepingTouching earsTouching pawsTouching tailBeing petRemoving toy from mouthOther
Name of dog #2*
How long have you had dog #2*
Where did you get dog #2?*
Sex of dog #2*

MaleFemale
Is dog #2 spayed/neutered?*

YesNo
Is dog #2 a rescue?*
What is dog #2’s birthdate?*

MonthDayYear
Date
What can you tell us about dog #2’s history? *
What is dog #2’s primary breed?*
What is dog #2’s primary color?*
What is dog #2’s weight in pounds?*
What is dog #2’s energy level?*

Very LowLowMediumHighVery High
Is dog #2 crate trained?*

YesNo
Does dog #2 like their crate?*

YesNo
Please tell us what dog #2's interests are.*

RunningPlaying with ballsPlaying with toysJumpingTricksEatingSleepingOther
Please select any attributes that accurately represent dog #2’s personality.*

PlayfulOutgoingShySubmissiveAffectionateInsecureGentleQuiteMouthyJumpyAvid BarkerExcitable
Please indicate any situations that may result in dog #2 becoming unfriendly or where they may react in a negative manner.*

Grabbing their collarHuggingBeing removed from furnitureBeing touched while sleepingTouching earsTouching pawsTouching tailBeing petRemoving toy from mouthOther
Name of dog #3*
How long have you had dog #3*
Where did you get dog #3?*
Sex of dog #3*

MaleFemale
Is dog #3 spayed/neutered?*

YesNo
Is dog #3 a rescue?*
What is dog #3’s birthdate?*

MonthDayYear
Date
What can you tell us about dog #3’s history? *
What is dog #3’s primary breed?*
What is dog #3’s primary color?*
What is dog #3’s weight in pounds?*
What is dog #3’s energy level?*

Very LowLowMediumHighVery High
Is dog #3 crate trained?*

YesNo
Does dog #3 like their crate?*

YesNo
Please tell us what dog #3's interests are.*

RunningPlaying with ballsPlaying with toysJumpingTricksEatingSleepingOther
Please select any attributes that accurately represent dog #3’s personality.*

PlayfulOutgoingShySubmissiveAffectionateInsecureGentleQuiteMouthyJumpyAvid BarkerExcitable
Please indicate any situations that may result in dog #3 becoming unfriendly or where they may react in a negative manner.*

Grabbing their collarHuggingBeing removed from furnitureBeing touched while sleepingTouching earsTouching pawsTouching tailBeing petRemoving toy from mouthOther
Name of dog #4*
How long have you had dog #4*
Where did you get dog #4?*
Sex of dog #4*

MaleFemale
Is dog #4 spayed/neutered?*

YesNo
Is dog #4 a rescue?*
What is dog #4’s birthdate?*

MonthDayYear
Date
What can you tell us about dog #4’s history? *
What is dog #4’s primary breed?*
What is dog #4’s primary color?*
What is dog #4’s weight in pounds?*
What is dog #4’s energy level?*

Very LowLowMediumHighVery High
Is dog #4 crate trained?*

YesNo
Does dog #4 like their crate?*

YesNo
Please tell us what dog #4's interests are.*

RunningPlaying with ballsPlaying with toysJumpingTricksEatingSleepingOther
Please select any attributes that accurately represent dog #4’s personality.*

PlayfulOutgoingShySubmissiveAffectionateInsecureGentleQuiteMouthyJumpyAvid BarkerExcitable
Please indicate any situations that may result in dog #4 becoming unfriendly or where they may react in a negative manner.*

Grabbing their collarHuggingBeing removed from furnitureBeing touched while sleepingTouching earsTouching pawsTouching tailBeing petRemoving toy from mouthOther
Have any of your dogs ever climbed a fence?*

YesNo
Have any of your dogs gone to daycare before? If yes, please explain.*
Have any of your dogs ever bitten a person? If yes, please describe.*
Have any of your dogs ever bitten another dog? If yes, please describe.*
Do any of your dogs guard resources (ie. food, toys,treats,or people)? If yes, please describe.*
Do any of your dogs have any health, allergies or dietary restirictions we should be aware of? Please explain.*
Do any of your dogs go to dog parks?*

YesNo
Have any of your dogs ever exhibited aggressive behavior towards other dog/people are the park such as mouthing, teething, fighting, or raising hackles?*
Are there any people your dog(s) dislike or fear?*
How do your dogs react to small dogs or puppies?*
Have any of your dogs ever growled or snapped at anyone who has tried to take food or toys away?*
Special instructions or other information we should know about*
Do you mind if your dog gets wet or plays in a dog pool or is giving a bath if we feel it is needed?*

When would you like to bring your dog(s). We are open three days a week at this time. Tuesday-Thursday 7am-6pm*

	Tuesday	Wednesday	Thursday
Full day
Half day

Please list anyone you are giving permission to pick up your dog from daycare. Name, relationship and phone number. Photo ID will be required to pick up you odg.*
How did you hear about us?*
Please upload a picture of your dog.

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