Daycare Evaluation Application

Daycare Evaluation Application

Any information you'd like to provide us will help us to make your pup feel more at home on their first day and meet their needs. We look forward to meeting you and your pup soon!
Owner's Name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Requested Evaluation Date (Mon-Fri)

MonthDayYear
Date
Requested Evaluation Time

:HourMinutesAM/PM Option
7:00AM to 3:00PM
until :HourMinutesAM/PM Option
Dog Information

Please submit one application for each dog who you would like to have in off-leash play
Dog's Name:*
How often do you plan to send your dog to daycare?
Breed (If a mix, list two predominant breeds in behavior):*
Current Age:*
Is your dog spayed/neutered? We require dogs to be spayed/neutered by 9 months of age for group play in daycare. Nursery School puppies are the exception to the 9 month spay/neuter rule.*

YesNo
Is your dog up to date on the following:*

RabiesDistemperBordetella/Kennel CoughFecal test within the past 6 months
Dog's Veterinarian:*
How long have you owned your dog?*
Where did you get your dog?

Animal ShelterAnimal Rescue GroupBreederPet StoreOnline AdFriendFound As A Stray
What knowledge do you have of your dog’s past history?
Why are you considering our daycare program for your dog? (check all that apply)

Play with other dogsSo not home aloneMy dog has separation anxietyExercise (primary source)Exercise (secondary source)Recommended by other pet professional (trainer, vet, etc.)
Which of the following best describes your dog’s level socialization with other dogs:
Has your dog had any problems previously in an off-leash social environment? (Check all that apply)

NoYes - Altercation or fight at a public dog parkYes - Altercation or fight with a neighbor or friend’s dogYes - Fearful reaction in a group of dogsYes - Dismissed from a prior dog daycare or social playgroup program (complete "other" option)
Only complete if you answered yes in above that your dog was dismissed from a prior program. What reason were you given as to why your dog was dismissed? Check each statement below that applies to the situation that resulted in your dog’s dismissal.

My dog was injured, no medical treatment requiredMy dog was injured and required medical treatmentAnother dog was injured, no medical treatment requiredAnother dog was injured and required medical treatmentA person was injured, no medical treatment requiredA person injured and required medical treatment
Provide any other comments you want us to know about this situation.
Household Information
Please provide information on other pets in household (breed, age, sex, gender):
How does your dog get along with other household animals?
Do any visitors bring their dog(s) to your house?

YesNo
Does your dog ever bark or growl at anyone passing outside your home or yard? Yes, No, If yes, please explain.
Are there any types and/or breeds of dogs your dog seems to automatically fear or dislike? Yes, No, 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 FemalesMales OnlyFemales Only
Please describe size, breed, & 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?
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 any of the following areas? If yes, please explain.
Mouthing:
Housetraining:
Barking:
Digging:
Ignoring Cues:
Dog Behavior Information
Are there any particular types of people your dog seems to automatically fear or dislike?
Has your dog ever growled at someone? If yes, If yes, what were the circumstances and how did you respond?
Has your dog ever bitten a person? If yes, what were the circumstances and how did you respond? Please describe any injuries if there were any.
Has your dog ever bitten another animal? If yes, what were the circumstances and how did you respond? Please describe any injuries if there were any.
Has your dog ever climbed/jumped a fence? If yes, what were the circumstances? How high was the fence?
Has your dog ever escaped from your house or yard? If yes, please explain the circumstances:
How would you describe the energy level of your dog?
Is your dog frightened by thunderstorms? If yes, describe typical behavior & what specifically helps to relax your dog or calm his/her fear.
Is your dog frightened or nervous around anything else? If yes, please explain.
Has your dog ever growled or snapped at a person who has taken food or toys away from him/her? If yes, what were the circumstances and how did you respond?
Has your dog ever growled or snapped at another dog who has taken food or toys away from him/her? If yes, what were the circumstances and how did you respond?
Other comments or information about your dog that you feel might be helpful?
Thank you for the time you spent completing the application form. We look forward to meeting you and your dog on evaluation day. Please contact us if you have any questions on the next steps of the evaluation process.
Should be Empty:

Daycare Evaluation Application

Dog Information

Household Information

Dog Behavior Information