Play group permission

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
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
Should be Empty:

Play Group Questionnaire & Permission Slip

Dog Health Profile:

Dog Personality Profile: