Doggies Day Out of Palm Springs Application

Dog Information

ONE application per dog. Please be as detailed as possible while filling out the application. DO NOT leave any question blank, your application will be deemed INCOMPLETE!
Owner's Name*
Today's Date*

MonthDayYear
Date
Dog's Name*
Male or Female?*
Breed*
Color*
Weight*
Dog's Date of Birth *

MonthDayYear
Date
How long have you owned your dog?*
Is your pup spayed/neutered?*

YesNo
If no, when do you plan on stay/neutering?*
Where did you get your dog?*

BreederAnimal ShelterFriendFound as StrayOther
What knowledge do you have of your dog's history that you feel is most important for us to know?*
Why are you considering our Doggie Daycare Program for your dog? Please check all that apply*

N/A - BOARDING ONLY. (We DO NOT want dog interaction.Training with Fernando (Please only check if you have been in contact with Fernando already)Play with other dogsSo not home aloneCHECK IF: Dog exhibits symptoms of separation anxietyRecommended by other pet professional (vet, trainer,ect.) Please provide reason below
Reason*
If none, type N/A
Has your dog ever scaled or jumped a 6ft fence?*

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

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

YesNo
If yes, check all that apply*

Altercation or fight at a public dog parkAltercation or fight with a neighbor or friend's dogFearful reaction in a group classDismissed from a prior dog daycare or social playgroup programN/A
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 that applies to the situation that resulted in your dogs dismissal.*

My dog was injured, no medical treatmentMy dog was injured and required medical treatmentAnother dog was injured, no medical treatmentAnother dog was injured and required medical treatmentA person was injured, no medical treatmentAnother person was injured and required medical treatmentN/A
Provide any other comments you want us to know about this situation*
If none, type N/A
Health History
Please describe your dogs flea/tick control and prevention program (if any)*
If none, type N/A
Does your dog have any physical disabilities?*

YesNo
Please explain disability and cause*
If none, type N/A
If you answered yes, what restrictions need to be placed on your dog's activities or movements?*

No jumpingNo runningNo hard playNo water playNo contact with other dogsN/A
Does your dog have any medical conditions OR food allergies/sensitivities?*

YesNo
If yes, please explain*
If none, type N/A
If medication is used to control the condition please provide name and dosage*
If none, type N/A
Please provide details of your dogs diet:
Type *
Kibble, Canned, Raw/Natural/Prescribed by vet
Brand *
Please provide exact Brand, Flavor, Specific Diet (ex. Adult, Puppy, Weight Loss, Sensitive Skin/Stomach)
Fish Oil (please provide amount per meal) *
ex. 1 pump AM/PM
Supplements*
ex. 1 vitamin AM/PM
Amount of Food Given*
Feeding Schedule*

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

YesNo
If yes, please explain*
Does your dog have any sensitive areas on his/her body?*

YesNo
If yes, where and how do they react?*
Household Information
Do you have any other pets in your household?*

YesNo
If yes, what kind and do they get along?*
Do visitors bring their dog(s) over to your house?*

YesNo
If yes, how do they get along?*
How does your dog react to a stranger coming into your home or yard?*
Has your dog ever shared his/her food or toys with other animals?*

YesNo
If no, how does your dog react to another dog approaching his/her food or toys?*
What kind of a collar do you use to walk your dog?*

BuckleNylon/Chain Choke CollarHarnessHead CollarProng/PinchOther
Has your dog ever gotten away from you or anyone while out for a walk?*

YesNo
If yes, please explain circumstances*
Is your dog crate trained?*

YesNo
How does your dog act in a kennel?*
Has your dog ever jumped on someone?*

YesNo
If yes, what were the circumstances?*
How does your dog react when they are upset?*
Does your dog have any problems in any of the following areas?*

MouthingHousetrainingBarkingDiggingIgnoring CommandsN/A
Dog Behavior Information
Has your dog ever bitten a person?*

YesNo
If yes, what were the circumstances and how did you respond, any injuries?*
Has your dog ever bitten another animal?*

YesNo
If yes, what were the circumstances and how did you respond, any injuries?*
How would you describe the energy level of your dog?*

LowMediumHigh
Has your dog ever chased or tried to chase a small animal?*

YesNo
If yes, what were the circumstances?*
Has your dog ever killed another animal (bird, rodent, small pet)?*

YesNo
If yes, what were the circumstances?*
Is your dog frightened of thunderstorms?*

YesNo
If yes, how do they react?*
Is your dog frightened or nervous around anything else?*

YesNo
If yes, please explain*
Does your dog ever bark or growl at people in public?*

YesNo
If yes, please explain*
Are there any types and/or breeds of dogs your dog seems to automatically dislike?*

YesNo
If yes, please explain*
Is your dog food motivated?*

YesNo
How does your dog react to another dog approaching him/her in public?*
Is your dog leash reactive?*

YesNo
Does your dog play with other dogs?*

YesNo
If yes, which type?*

Male and FemaleMale OnlyFemale Only
Please describe the size and temperament of the other dogs*
Does your dog play rough with other dogs?*

YesNo
Does your dog play rough with humans?*

YesNo
Please provide any other comments or information about your dog that you feel will be helpful*
Thank you for the time you spent completing the application form!

Please be sure you have filled out our WAIVER as well! Your next step is to email us your dog’s vaccine records. You may bring them in with the application and waiver OR email them to play@doggiesdayoutofps.com.

We look forward to meeting you and your pup on their first day! Please let us know if you have any questions!
Should be Empty:

Dog Information

Health History

Please provide details of your dogs diet:

Household Information

Dog Behavior Information