Play & Behavior Form

OWNER INFORMATION

Owner’s Name(s)

Owner's Email

Today's Date

DOG INFORMATION

Dog's Name

Breed

If a mix, list two predominant breeds in behavior.

1a. Current age

1b. How long have you owned your dog?

2a. Where did you get your dog?

2b. What knowledge do you have of your dog’s past history?

3. Why are you considering our off-leash dog play program for your dog?

Play with other dogs

So not home alone

Reduce symptoms of separation anxiety

A primary source of exercise

An additional source of exercise

Recommended by other pet professional (trainer, vet, etc.)

If so, reason playgroup was recommended?If so, reason playgroup was recommended?

OtherOther

Check all that apply

4. Which of the following best describes your dog’s level socialization with other dogs?

None – No knowledge of other dog interaction

Minimal – On leash encounters only

Moderate – Some off-leash playtime on occasion with visitor's/neighbor's/friend's dogs

Extensive – Regular visits to dog social events, off-least dog parks, dog daycare, etc.

5. Has your dog had any problems previously in an off-leash social environment?

No

Yes (check all that apply below)

Altercation or fight at a public dog park

Altercation or fight with a neighbor or friend's dog

Fearful reaction in a group of dogs

Dismissed from a prior dog daycare or social playgroup program (complete item 5b below)

Other (please describe)Other (please describe)

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

My dog was injured. No medical treatment required.

My dog was injured. Required medical treatment required.

Another dog was injured. No medical treatment required.

Another dog was injured. Required medical treatment required.

A person was injured. No medical treatment required.

A person dog was injured. Required medical treatment required.

Provide any other comments you want us to know about this situation.Provide any other comments you want us to know about this situation.

Check each statement above that applies to the situation that resulted in your dog's dismissal.

HEALTH HISTORY

6. Please describe your dog’s flea/tick control and prevention program:

7. Does your dog have any allergies?

No

Yes

If yes, please explain.

8. Does your dog have any physical disabilities?

No

Yes

If yes, please explain disability and cause.

If yes, what restrictions need to be placed on your dog's activities or movements?

No jumping

No running

No hard play

No contact with other dogs

Other (please explain)Other (please explain)

9. Does your dog have any medical conditions?

No

Yes

If yes, please explain. If medication is used to control the condition, please provide name and dosage.

10. Provide details of your dog's diet:
a. type (kibble, canned, raw/natural):
b. brand (Innova, Iams, Purina, etc):
c. primary protein source:
d. feeding schedule:

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

12. Does your dog have any bathroom-related issues or concerns?

13a. How often do you brush or comb your dog's coat?

13b. How does your dog react to having his/her nails clipped?

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

No

Yes (if yes, where?)Yes (if yes, where?)

15. Where are your dog's favorite petting spots?

16a. How frequently is your dog walked outside?

16b. How long are your walks?

17. 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 dogs.

Mild Exerciser: Short daily walks and/or regular playtime with human or other dogs.

Mild Exerciser: Long or multiple walks daily and/or regular playtime with human or dogs

Athlete: Regular jobs/runs and/or regular participation in a dog sport activity such as agility, flyball, frisbee, etc.

HOUSEHOLD INFORMATION

Household Pets

Breed

Age

Gender

Male

Female

Spayed or Neutered?

No

Yes

Add Pet Remove Pet

Do you have cats?

No

Yes (If yes, how many cats do you have?)Yes (If yes, how many cats do you have?)

How does your dog get along with your cats?

How does he react to unfamiliar cats he sees on walks?

19a. Does your dog like children?

No

Yes

19b. How does your dog behave around children?

19c. How does your dog get along with other household animals?

20. Do any visitors bring their dog(s) to your house?

No

Yes

If yes, how do they get along?

21. How does your dog react to a stranger coming into your home or yard?

22.How does your dog ever bark or growl at anyone passing outside your home or yard?

No

Yes

If yes, please explain.

23. Are there any types and/or breeds of dogs seems to automatically fear or dislike?

No

Yes

If yes, please describe?

24. How does your dog react to puppies?

25a. ON LEASH: How does your dog react to another dog approaching him/her in a park, at the beach, or on a walk?

25b. OFF LEASH: How does your dog react to another dog approaching him/her in a park, at the beach, or on a walk?

26. Does your dog play with other dogs?

No

Yes

If yes, which type?

Males & females

Only males

Only females

If yes, please describe size, breed and temperament of the other dogs.

27. What kinds of games does your dog play with other dogs?

28. What kind of games does your dog play with people.

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

No

Yes

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

30. Which commands does your dog know?

(Please check all that apply.)

31. How did your dog get his/her obedience training/

Attended one group class

Attended more than one level of group obedience classes (beginner and intermediate, etc.)

Dog was sent to a board and train program

Private sessions in home

Other, please explain:Other, please explain:

(Please check all that apply.)

32. Which of the following best describes the use of obedience cues with your dog at home?

Key part of daily communication

Used when we go on walks or have people over

Used occasionally to better control behavior

Rarely used

Not applicable

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?

No

Yes

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

No

Yes

If yes, please explain circumstances:

36. Where does your dog sleep?

Inside the house

Outside the house

Inside/Outside (varies)

In which room in the house does your dog sleep?

Where in the room does your dog sleep?

Crate

Owner's bed

Dog cushion/bed on floor

Other (pls describe)Other (pls describe)

37. Has your dog ever jumped up on someone?

No

Yes

If yes, what were the circumstances?

38. How does your dog act when you get home at the end of the day?

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

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

41. Is your dog allowed on the furniture at home?

No

Yes

42. Does your dog have any problems in any of the following areas?

MouthingMouthing

House-trainingHouse-training

BarkingBarking

DiggingDigging

Ignoring commandsIgnoring commands

None of the above

43. Does your dog know any tricks?

No

Yes

If yes, please explain:

DOG BEHAVIOR INFORMATION

44. Are there any particular types of people your dog seems to automatically fear or dislike?

45. Has your dog ever growled at someone?

No

Yes

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

46. Has your dog ever bitten a person?

No

Yes

If yes, what were the circumstances and how did you respond? Please describe injuries (if any).

47. Has your dog ever bitten another animal?

No

Yes

If yes, what were the other circumstances and how did you respond? Please describe any injuries if there were any.

48. To the best of your knowledge, what does your dog do when you are not at home?

49. Has your dog ever climbed/jumped a fence?

No

Yes

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

50. Has your dog ever escaped from your house or yard?

No

Yes

If yes, please explain the circumstances.

51. How would you describe the energy level of your dog?

Low

Medium

High

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

No

Yes

If yes, what were the circumstances?

53. Has your dog ever chased someone (or wanted to) on a skateboard or bicycle?

No

Yes

If yes, what were the circumstances?

54. Is your dog frightened by thunderstorms?

No

Yes

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

55. Is your dog frightened or nervous around anything else?

No

Yes

If yes, please explain

56. Does your dog play with any toys?

No

Yes

If yes, what kinds of toys does your dog like?

57. Has your dog ever growled or snapped at a person who has taken food or toys away from him/her?

No

Yes

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

58. Has your dog ever growled or snapped at another dog who has taken food or toys away from him/her?

No

Yes

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

59. Have you ever noticed your dog stopping and staring at another animal?

No

Yes

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

60. 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.

doggy play & behavior form

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OWNER INFORMATION

DOG INFORMATION

HEALTH HISTORY

HOUSEHOLD INFORMATION

Household Pets

DOG BEHAVIOR INFORMATION

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doggy play & behavior form

please fill this out entirely!

OWNER INFORMATION

DOG INFORMATION

HEALTH HISTORY

HOUSEHOLD INFORMATION

Household Pets

DOG BEHAVIOR INFORMATION

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

Our Instagram

GET IN TOUCH

LOCATION

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