Play Group Questionnaire & Permission Slip
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Pet's Name
Breed:
Color
Age
Sex
*
Male
Female
My pet is
*
At least 6 months old
under 6 months old
spayed / neutered
still intact (not spayed/ neutered)
Dog Health Profile:
Does your dog have any old injuries or restrictions that we should be aware of? Please explain.
Is your dog currently taking any medications? ( If so, for what ailment)
Dog Personality Profile:
Has your dog ever been in a social play group before (dog daycare, dog park, etc)?
*
Yes
No
Unsure
If yes, what type of situation?
Breed:
What size dogs does your dog play with
Small
Medium
Large
All
Type a question
Has your dog ever shown any of the following behavior towards other dogs
*
growling
showing teeth
lunging
bite to cause harm
tuck tail
try to get away from
squeal out of fear
hump other dogs
barking
snap at
not no when to stop playing
none
Has your dog ever been in an altercation with another dog? If yes, explain
Please describe the situation(s) the behavior occurred
Has your dog ever shown any of the following behavior towards humans
*
growling
show teeth
lunging
bite to cause harm
tuck tail
try to get away from
squeal out of fear
hump other dogs
barking
snap at
none
Please describe the situation(s) the behavior occurred
Is your dog possessive over
*
toys
people
food
water
None that Im aware of
Which best describes your dogs play style
*
Class Clown -goofy,playful,high energy ,always on the go
Big Man on Campus- Alpha dog, chooses to stand tall to show he's the top dog
Cheerleader- an opinionated and vocal dog that tells the other dogs what he/she thinks
Referee-tends to be vocal and get in the middle of others when playing or running
Teacher's pet-shy, prefers to sit out of the group and watch without getting too involved
Over Achiever-the dog that is always involved in everything and everyone's business
Unsure
Signature
*
Clear
Submit
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