Doggie’s Day Out of Palm Springs Boarding and Off-Leash Play Application

We love dogs and want your dog to love coming to our Doggie Day Care, Boarding, and Training Center. No one knows your dog better than you, so we’d appreciate you taking the time to fill out this application. The more we know about the dogs in our care, the better we will be able to serve you and your pet.

Owner's Name *

First Name Last Name

Second Owner's Name

First Name Last Name

Today's Date

Date

Dog Information

Up to TWO pups can be listed on one application, making notes to identify any important information. Additional application required if needing care for more than two pups.

Dog's Name *

Second Dog's Name

Breed *

If a mix, list two predominant breeds

Dog's Date Of Birth - Can be estimated if needed *

Date

How long have you owned your dog? *

Color *

Weight *

Where did you get your dog? *

Newspaper Ad Breeder Pet Store Animal Shelter Animal Rescue Group Friend Found As Stray Other

Is your pup spayed/neutered? *

Yes No - DAY CARE guests must be spay/neutered by age of 9 months. *Ask about BOARDING options for unaltered pups.

What knowledge (if any) do you have of your dog’s past history that you feel is most important for us to know?

Why are you considering our Doggie Day Care program for your dog? (check all that apply) *

N/A – BOARDING ONLY. We are BOARDING ONLY and not considering Doggie Day Care. Play with other dogs So they're not home alone Exercise Recommended by other pet professional (trainer, vet, etc.)

If your reason is so your dog won't be home alone, does your dog exhibit symptoms of separation anxiety? (Answer only if applicable)

Yes No

If your reason is exercise, would it be for their primary source of exercise, or an additional source of exercise? (Answer only if applicable)

Primary Exercise Additional Exercise

If your reason is that you were recommended by a pet professional (trainer, vet, etc) what is the reason? (Answer only if applicable)

Has your dog ever scaled or jumped a fence? *

Yes No

Is your dog able to scale a 6ft fence? *

Yes No

Which of the following best describes your dog’s level 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.

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

Yes No

If yes, please 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 day care or social playgroup program (complete below)

Only complete if you answered YES that your dog was dismissed from a prior program. 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.

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 andrequired medical treatment

Provide any other comments you want us to know about this situation.

Please describe your dog’s flea/tick control and prevention program (if any).

Does your dog have any physical disabilities? *

Yes No

If yes, please explain disability and cause.

If yes, 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

Does your dog have any medical conditions? *

Yes No

If yes, please explain.

If medication is required, please provide name and dosage.

Provide details of your dog’s diet – PET OWNERS ARE REQUIRED TO PROVIDE PETS FOOD FOR THE ENTIRE DURATION OF STAY. THOUGH WE DO INQUIRE ABOUT PET’S DIETS IN THE QUESTIONNAIRE, DOGGIE’S DAY OUT DOES NOT PROVIDE YOUR PET’S FOOD.

Type (kibble, canned, raw/natural) *

Brand (Innova, Iams, Purina, etc) *

Amount of food given and feeding schedule *

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

Does your dog like to be brushed? *

Yes No

If no, what have you tried to make it more enjoyable?

Does your dog have any sensitive areas on his/her body? *

Yes No

If yes, where?

Where is your dog's favorite petting spots?

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 jogs/runs/or regular participation in a dog sport activity such as agility, flyball, frisbee, etc.

Pet 1 Breed

Age

Sex

Male Female

Spayed/Neutered

Yes No

Pet 2 Breed

Age

Sex

Male Female

Spayed/Neutered

Yes No

Pet 3 Breed

Age

Sex

Male Female

Spayed/Neutered

Yes No

Pet 4 Breed

Age

Sex

Male Female

Spayed/Neutered

Yes No

Do any visitors bring their dog(s) to your house? *

Yes No

If yes, how do they get along?

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

Does your dog ever bark or growl at anyone passing outside your home or yard? *

Yes No

If yes, please explain.

Are there any types and/or breeds of dogs your dog seems to automatically fear or dislike? *

Yes No

If yes, please describe.

Is your dog food motivated? *

Yes No

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

Does your dog play with other dogs? *

Yes No

If yes, which type?

Male and Female Only Males Only Females

Please describe size and temperament of the other dogs *

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

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

Has your dog ever shared his/her food or toys with other animals? *

Yes No

If yes, how does your dog react to another dog approaching his/her food or toys?

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

Sit Stay Down Come Heel Rollover High Five Other

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 sessions in home Other

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 occasionally to better control behavior Rarely used Not applicable

What kind of a collar do you use to walk your dog? Doggie’s Day Out does not permit use of “Flexi” leashes. Please bring your pup in on a regular flat, leather, nylon, ropelead, etc. “Flexi” leashes do not provide proper control of pups. *

Buckle Nylon/Chain Choke Collar Harness – Leash Clips on Back Harness – Front Clip Head Collar Prong/Pinch Other

Is it effective at keeping him/her under control? *

Yes No

Has your dog ever gotten away from someone when out for a walk? *

Yes No

If yes, please explain the circumstances.

Is your dog crate trained? *

Yes No

Has your dog ever jumped up on someone? *

Yes No

If yes, please explain the circumstances.

Where does your dog sleep?

Crate Owner's Bed Dog cushion/Bed on floor Other

How does your dog act when you get home at the end of the day? *

What does your dog do to show he/she is happy? *

What does your dog do to show he/she is upset? *

Does your dog have any problems in any of the following areas?

Mouthing Housetraining Barking Digging Ignoring commands

If any, please explain.

Does your dog know any tricks? *

Yes No

If yes, please describe.

Doggie’s Day Out of Palm Springs Boarding and Off-Leash Play Application

Dog Information

Health History

Household Information