CEDARBURG PET CARE LLC

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OFF LEASH PLAY APPLICATION

Email *

Today's Date *

YYYY

I am interested in:
*

Day Boarding (small group daycare)

Main House Sleepover

Required

Owner's Name(s): *

Owner's Email Address: *

Owner's Phone # *

Owner's Street Address: *

Dog's Name: *

Breed: If a mix, list two predominant breeds in behavior: *

Dog's Sex: *

Female

Male

1a. Dogs Birthdate/Age: *

Is your dog spayed or neutered? *

Yes

1b. How Long have you owned your dog?: *

2. Where did you get your dog? *

Breeder

Animal Shelter/Rescue Group

Found as Stray

Other:

3. What knowledge do you have of your dog's past history?: *

4. Which of the following best describes your dog's level of 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 dog(s)

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

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

Yes. If Yes, check all that apply:

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)

Required

5b. Only complete if you answered yes in 5a, that your dog was dismissed from a prior program. What reason were you given as to why your dog was dismissed?

My dog was injured, no medical treatment required

My dog was injured and required medical treatment

Another dog was injured, no medical treatment required

Another dog was injured and required medical treatment

A person was injured, no medical treatment required

A person injured and required medical treatment

Other:

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

7. Does your dog have any allergies? If Yes, click other and explain: *

Yes

Other:

Required

8a. Does your dog have any physical disabilities? If yes, complete question 8b. *

Yes

8b. If you answered yes to question 8a, 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:

9. Does your dog have any medical conditions? If yes, please Click "Other" and explain: *

Yes

Other:

Required

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

11. On what type of surface does your dog generally go to the bathroom (ex grass, mulch, pee pads)? *

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

13a. Does your dog liked to be brushed? 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 area on his/her body? If yes, please explain where? *

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

16. How frequently is your dog walked outside? How long are the 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.

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

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

18a. What other pets do you have in the household? Breed, Age, Sex, Spayed or Neutered? *

18b. How does your dog get along with the other household animals? *

19a, Does your dog like children? *

Yes

19b. How does your dog behave around children? *

20a. Do any visitors bring their dog(s) to your house? If yes, please answer question 20b. *

Yes

Required

20b. If you answered yes to 20a, please explain how your dog reacts to your visitor's dog(s).

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

22. Does your dog ever bark or growl at anyone passing outside your home or yard? If yes, please click "Other" and explain how your dog reacts to anyone passing outside your home or yard. *

Yes

Other:

Required

23. Are there any types and/or breeds of dogs your dog seems to automatically fear or dislike? If yes, please describe. *

24. How does your dog react to puppies? *

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

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

26a. Does your dog play with other dogs? If yes, please answer 26b and 26c. *

Yes

26b. Please describe sex, size, breed, & temperament of the dogs that your dog plays with:

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

28. What kinds of games does your dog play with people? *

29a. Has your dog ever shared his/her food or toys with other animals? If you answer yes, please complete question 29b. *

Yes

29b. If you answered yes to question 29a, please explain how your dog reacts to another dog approaching his/her food or toys.

30. Which commands does your dog know? (please check all that apply) *

Sit

Stay

Down

Come/Here

Heel

Rollover

Kisses

Shake/High Five

Other:

Required

31. How did your dog get his/her obedience training (Please check all that apply)? *

Attended one group class

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

Dog was sent to a board and train program

Private session in home

Other:

Required

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 occastionally to better control behavior

Rarely used

Not applicable

Required

33. What kind of a collar do you use to walk your dog? *

Buckle

Nylon/chain choke collar

Harness - Leash clips on back

Harness - Front clip

Head collar

Prong/pinch collar

Other

Required

34. Is the collar you use effective in keeping your dog under control? *

Yes

35a. Has your dog ever gotten away from someone when out for a walk? If yes, please answer question 35b. *

Yes

35b. If you answered yes to question 35a, please explain the circumstances of the time(s) your dog has gotten away from someone when out for a walk:

36. Where does your dog sleep? *

Inside the house - Crated

Inside the house - Owner's Bed

Inside the house - Dog cushion/bed on floor

Outside the house

Other:

Required

37. Has your dog ever jumped on someone? 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? *

42a. Does your dog have any problems with any of the following? If checked any, please complete question 42b. *

Mouthing

Housetraining

Barking

Digging

Ignoring Commands

Other:

Required

42b. Please explain any boxes checked in 42a.

43. Does your dog know any tricks? If yes, please describe. *

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

45. Has your dog ever growled at someone? If yes, what were the circumstances and how did you respond? *

46. Has your dog ever bitten a person? If yes, what were the circumstances and how did you respond? Please also describe injuries (if any). *

47. Has your dog ever bitten another animal? If yes, what were the circumstances and how did you respond? Please describe any injuries (if any). *

48. To the best of your knowledge, what does your dog do when you're not home? *

49. Has your dog ever climbed/jumped the fence? If yes, what were the circumstances? How high was the fence? *

50. Has your dog ever escaped from your house or yard? If yes, please explain the circumstances. *

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

Low

Medium

High

52. Has your dog ever chased or tried to chase a small animal? If yes, what were the circumstances? *

53. Has your dog ever chased someone (or wanted to) on a skateboard or bicycle? If yes, what were the circumstances? *

54. Is your dog frightened by thunderstorms? If yes, please describe typical behavior and what specifically helps to relax your dog or calm his/her fear. *

55. Is your dog frightened or nervous around anything else? If yes, please explain *

56. Does your dog play with any toys? 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 toys away from him/her? 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? If yes, what were the circumstances and how did you respond? *

59. Have you ever noticed your dog stopping and staring at another animal? If yes, what were the circumstances? *

60. Other comments or information about your dog that you feel might be helpful? *

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