Owner's Name *
Owner's Name
Today's Date
Today's Date
Dog Information
Please submit one application for each dog.
2.a 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.a Has your dog had any problems previously in an off-leash social environment?
If Yes, check all that apply
5.b 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.
Health History
If yes, please explain:
Please explain disability and cause:
If yes, please explain. If medication is used to control the condition, please provide name and dosage:
a. type (kibble, canned, raw/natural) b. brand (Innova, Iams, Purina, etc.) c. primary protein source d. feeding schedule
e.g., grass, mulch, pee pads?
If no, what have you tried to make it more enjoyable?
If yes, where?
17. Check the box below that best represents your dog's overall level of exercise routine:
Include Breed, Age, Sex, and if they are Spayed/Neutered
19.a Does your do like children?
If yes, please explain:
If yes, please describe:
On Leash? Off Leash?
30. Which commands does your dog know?
(please check all that apply)
31. How did your dog get his/her obedience cues with your dog at home?
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 it effective in keeping him/her under control?
36.a Where does your dog sleep?
42.a Does your dog have any problems in any of the following areas?
42.b If yes, please explain:
Dog Behavior Information