CLUB BELLY RUB DOG DAYCARE APPLICATION
Date Name
Address City: Zip: Home Phone: Work: Cell: Email: Spouse/Partner Name: Home Phone: Work: Cell:
Emergency Contact Name: Phone: Others authorized to pick up my dog:
Pet’s Name: Sex: Male Female Birthday: Breed: Color: Weight:
Veterinarian: Address: Phone:
Vaccinations (Date last given): (you can submit a printout from the vet instead) DHLPP Rabies Bordatella Spayed/Neutered If no, when is it scheduled?
HOW DID YOU HEAR ABOUT CLUB BELLY RUB?
Do you have knowledge of your dog’s past history? Yes No If yes, please describe
Number of People in your household: Adult males: Adult females: Children / ages:
List other animals in your household: Species Breed Age Altered? Sex
How does your dog get along with other animals in your home?
Does your dog have any medical problems or physical disabilities? Yes No
If yes, what restrictions need to be placed on your dog’s activities? No jumping No running No hard play Other (please describe)
Is your dog currently taking flea and tick preventative? Yes No
Is your dog taking any medications? Yes No Please describe
Does your dog have any allergies? Yes No Please describe
Does your dog like to be brushed? Yes No Is your dog easily handled by you? Yes No By your vet? Yes No
How does your dog react when you lead them by the collar? Does Fine Does OK, but pulls away Doesn’t like to be lead by the collar
Does your dog have any areas on his body where he does not like to be touched? Yes No Please state which areas
Where does your dog like to be petted? How does your dog get exercised? How often? Describe your dogs activity level: Couch Potato Moderately Activity Very Active
Has your dog had any formal obedience training? Yes No When and where? What commands does your dog know?
What percent of time does your dog respond to their commands? At home Outside
Is your dog crate trained? Yes No
Does your dog have a problem with (mark all that apply) Excessive barking Jumping Mouthiness Eating Stool
What does your dog do when you are not home? How does your dog show he/she is happy? Describe your dogs’ personality Shy Mellow Out Going Excitable Active Couch Potato Rambunctious Content to be around others Slow to warm
What is your dogs’ favorite… Toy Treat Activity Place in the house
How often does your dog get socialization with other people? None Minimal Moderate Frequent Are there any kinds of people your dog automatically fears or dislikes? Yes No Please describe
Have you tried taking food, toys or bones away from your dog? Yes No What happened?
Has anyone else tried taking food, toys or bones away from your dog? Yes No What happened?
Do visitors bring their dog to your home? Yes No If Yes, how does your dog respond?
Has your dog shared food/toys with another dog? Yes No
How often does your dog get socialization with other dogs? None Minimal Moderate Frequent
Does your dog have off leash play with other dogs? Yes No Where and how often? Are there any sizes/breeds of dogs your dog automatically fears or dislikes? Yes No Please describe
How does your dog react to other dogs on leash?
How does your dog interact with: Big dogs Does well Doesn't do well Doesn't care Small dogs Does well Doesn't do well Doesn't care Older dogs Does well Doesn't do well Doesn't care Puppies Does well Doesn't do well Doesn't care
What kind of games does your dog play with other dogs? Wrestle Chase Tug Other:
Does your dog prefer to play with: male dogs female dogs no preference
Has your dog ever growled at someone? Yes No What were the circumstances?
Has your dog ever bitten someone? Yes No What were the circumstances?
Has your dog ever climbed or jumped over a fence? Yes No How high was it?
Will your dog need to be fed while he/she is in daycare? Yes No If yes, tell us when and how feeding is to take place and what food you will be providing:
What are your goals for having your dog attend daycare?
Additional comments or other information we should know about your dog:
