doggy play & behavior form

please fill this out entirely!

Off-Leash Play Application

OWNER INFORMATION

DOG INFORMATION

If a mix, list two predominant breeds in behavior.
2a. Where did you get your dog?
3. Why are you considering our off-leash dog play program for your dog?
Check all that apply
4. Which of the following best describes your dog’s level socialization with other dogs?
5. Has your dog had any problems previously in an off-leash social environment?
Only complete this question if you answered YES in 5 that your dog was dismissed from a prior group. What reason were you given as to why your dog
Check each statement above that applies to the situation that resulted in your dog's dismissal.

HEALTH HISTORY

7. Does your dog have any allergies?
8. Does your dog have any physical disabilities?
If yes, what restrictions need to be placed on your dog's activities or movements?
9. Does your dog have any medical conditions?
14. Does your dog have any sensitive areas on his/her body?
17. Check the box below that best represents your dog’s overall level of exercise routine?

HOUSEHOLD INFORMATION

Household Pets

Gender
Spayed or Neutered?
Do you have cats?
19a. Does your dog like children?
20. Do any visitors bring their dog(s) to your house?
22.How does your dog ever bark or growl at anyone passing outside your home or yard?
23. Are there any types and/or breeds of dogs seems to automatically fear or dislike?
26. Does your dog play with other dogs?
If yes, which type?
29. Has your dog ever shared his/her food or toys with other animals?
30. Which commands does your dog know?
(Please check all that apply.)
31. How did your dog get his/her obedience training/
(Please check all that apply.)
32. Which of the following best describes the use of obedience cues with your dog at home?
33. What kind of a collar do you use to walk your dog?
34. Is your dog's collar effective in keeping him/her under control?
35. Has your dog ever gotten away from someone when out for a walk?
36. Where does your dog sleep?
Where in the room does your dog sleep?
37. Has your dog ever jumped up on someone?
41. Is your dog allowed on the furniture at home?
42. Does your dog have any problems in any of the following areas?
43. Does your dog know any tricks?

DOG BEHAVIOR INFORMATION

45. Has your dog ever growled at someone?
46. Has your dog ever bitten a person?
47. Has your dog ever bitten another animal?
49. Has your dog ever climbed/jumped a fence?
50. Has your dog ever escaped from your house or yard?
51. How would you describe the energy level of your dog?
52. Has your dog ever chased or tried to chase a small animal?
53. Has your dog ever chased someone (or wanted to) on a skateboard or bicycle?
54. Is your dog frightened by thunderstorms?
55. Is your dog frightened or nervous around anything else?
56. Does your dog play with any toys?
57. Has your dog ever growled or snapped at a person who has taken food or toys away from him/her?
58. Has your dog ever growled or snapped at another dog who has taken food or toys away from him/her?
59. Have you ever noticed your dog stopping and staring at another animal?

Where your dog enjoys exceptional care and love while you're busy or traveling

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GET IN TOUCH

Phone:
541-382-9223

E-mail:
info@bendunleashed.com

LOCATION 

Gibson Air Rd.  Bend, OR 97701

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