New Student Summer Camp Enrollment

Summer Camp Enrollment

Please take a moment to fill out the following information so that we may better serve you.
Your 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
When Are You Hoping To Begin Summer Camp?

MonthDayYear
Date
How many days each week are you looking to attend (please outline which days as well - Camp runs Mondays-Thursdays)
Dog Information
Puppy's Name:*
Breed (If a mix, list two predominant breeds in behavior):*
Current Age:*
Dog's Veterinarian:*
Where did you get your dog?*

Animal ShelterAnimal Rescue GroupBreederPet StoreOnline AdFriendFound As A StrayOther
What knowledge do you have of your puppy's past history?
Which of the following best describes your puppy's level of socialization with other dogs:*
Has your puppy 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)Other
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 treatmentOther
Provide any other comments you want us to know about this situation.
Health History
Please describe your puppy’s flea/tick control and prevention program:*
Does your puppy have any allergies? (If yes, please outline) *
Does your puppy have any physical limitations? If yes, please explain.*
If answered yes, what restrictions need to be placed on your puppy’s activities or movements?

No jumpingNo runningNo hard playNo contact with other dogsOther
Does your puppy have any medical conditions? If yes, please explain. If medication is used to control the condition, please provide name and dosage.
Provide details of your puppy's diet –a. type (kibble, canned, raw/natural): b. brand (Innova, Iams, Purina, etc.): c. primary protein source:d. feeding schedule:
Does your puppy have any bathroom-related issues or concerns?
How frequently is your puppy walked outside?*
How long are your walks?*
Check the box below that best represents your puppy's overall level of exercise routine:*
Household Information
Which cues does your puppy know? (please check all that apply)*

SitStayDownComeHeelRoll OverKissesHigh FiveOther
What kind of a collar do you use to walk your puppy?*

BuckleNylon/Chain Choke CollarHarness – Leash Clips on BackHarness – Front ClipHead CollarProng/PinchOther
Is it effective in keeping him/her under control?*
Has your puppy ever gotten away from someone when out for a walk?*

YesNoOther
Puppy Behavior Information
Has your puppy ever aggressively growled, snapped, or bitten, any human or other animal?*
Has your puppy ever growled or snapped at a person or other 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 puppy for camp! Please contact us if you have any questions on the next steps.
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Summer Camp Enrollment

Dog Information

Health History

Household Information

Puppy Behavior Information