University Evaluation Application

University Evaluation Application
Owner's Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Requested Evaluation Date (Mon-Fri)

MonthDayYear
Date
Dog Information

Please submit one application for each dog who you would like to have in off-leash play
Dog's Name:*
How often do you plan to send your dog to University?
Breed (If a mix, list two predominant breeds in behavior):*
Current Age:*
Is your dog spayed/neutered?*

YesNo
Is your dog up to date on the following:*

RabiesDistemperBordetella/Kennel CoughFecal test within the past 6 months
Dog's Veterinarian:*
How long have you owned your dog?*
Where did you get your dog?*

Animal ShelterAnimal Rescue GroupBreederPet StoreOnline AdFriendFound As A Stray
What knowledge do you have of your dog’s past history?
Why are you considering our University program for your dog? (check all that apply)*

Play with other dogsSo not home aloneMy dog has separation anxietyExercise (primary source)Exercise (secondary source)Recommended by other pet professional (trainer, vet, etc.)
Which of the following best describes your dog’s level socialization with other dogs:*
Has your dog had any problems previously in an off-leash social environment? (Check all that apply)*

NoYes - Altercation or fight at a public dog parkYes - Altercation or fight with a neighbor or friend’s dogYes - Fearful reaction in a group of dogsYes - Dismissed from a prior dog daycare or social playgroup program (complete "other" option)
Only complete if you answered yes in above 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 requiredMy dog was injured and required medical treatmentAnother dog was injured, no medical treatment requiredAnother dog was injured and required medical treatmentA person was injured, no medical treatment requiredA person injured and required medical treatment
Provide any other comments you want us to know about this situation.
Household Information
Please provide information on other pets in household (breed, age, sex, gender):
How does your dog get along with other household animals?*
Do any visitors bring their dog(s) to your house?*

YesNo
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 explain.*
How does your dog react to puppies?*
How does your dog react to another dog approaching him/her in a park, at the beach, or on a walk? On Leash? Off Leash?*
Does your dog play with other dogs?*

YesNo
If yes, which type?

Males and FemalesMales OnlyFemales Only
Please describe size, breed, & temperament of the other dogs.
Has your dog ever shared his/her food or toys with other animals?*

YesNo
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)*

SitStayDownComeHeelRoll OverKissesHigh Five
How did your dog get his/her obedience training? (Please check all that apply)

Attended one group classAttended more than one level of group classes (beginner and intermediate,etc.)Dog was sent to a board and train programPrivate sessions in home
Which of the following best describes the use of obedience cues with your dog at home?*
What kind of a collar do you use to walk your dog?*

BuckleNylon/Chain Choke CollarHarness – Leash Clips on BackHarness – Front ClipHead CollarProng/Pinch
Is it effective in keeping him/her under control?*
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? If yes, please explain.
Mouthing:
Housetraining:
Barking:
Digging:
Ignoring Cues:
Dog Behavior Information
Are there any particular types of people your dog seems to automatically fear or dislike?*
Has your dog ever growled at someone? If yes, If yes, what were the circumstances and how did you respond?*
Has your dog ever bitten a person? If yes, what were the circumstances and how did you respond? Please describe any injuries if there were any.*
Has your dog ever bitten another animal? If yes, what were the circumstances and how did you respond? Please describe any injuries if there were any.*
Has your dog ever climbed/jumped a fence? If yes, what were the circumstances? How high was the fence?*
Has your dog ever escaped from your house or yard? If yes, please explain the circumstances:
How would you describe the energy level of your dog?*
Has your dog ever chased or tried to chase a small animal? If yes, what were the circumstances?*
Has your dog ever chased someone (or wanted to) on a skateboard or bicycle? If yes, what were the circumstances?*
Is your dog frightened by thunderstorms? If yes, describe typical behavior & what specifically helps to relax your dog or calm his/her fear.
Is your dog frightened or nervous around anything else? If yes, please explain.
Has your dog ever growled or snapped at a person who has taken food or toys away from him/her? If yes, what were the circumstances and how did you respond?*
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?*
Other comments or information about your dog that you feel might be helpful?
Thank you for the time you spent completing the application form. We look forward to meeting you and your dog on evaluation day. Please contact us if you have any questions on the next steps of the evaluation process.

Evaluation Fee

Evaluation Day (2 Hours)$50.00

Your dog will be scheduled for a 2 hour evaluation day, paired one-on-one with a trainer for their appointment. We will assess their sociability, comfort with the team members and environment, training activities, and more.

Total $0.00

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University Evaluation Application

Dog Information

Household Information

Dog Behavior Information

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