ULTIMUTT Puppy Preschool & Kindergarten Application

Ultimutt Knoxville Preschool & Kindergarten Information

For puppies between 14 weeks and 10 months, and up to about 40 pounds. Please fill out the form entirely, one for each pet.
Name*

First NameLast Name
Email*
example@example.com
We communicate primarily through email. What is the best method for initial contact about this puppy daycare application?*

TextPhone callEmail
Phone Number*
Please enter a valid phone number.
Dog's Name*
Breed / Color(s)*
Gender?*

MaleFemale
Is your dog spayed or Neutered yet? Note: dogs not spayed or neutered after 6 months will not participate in group play for their safety until after their surgery. They have one-on-one play*

YesNo
Approximate weight?*
Puppy's date of birth (or best guess)*

MonthDayYear
Where did you get your puppy?*
Medical History and Information
What veterinary clinic do you use? *
What is your veterinary clinic's phone number?*
VACCINATIONS

We require proof of the following:

• *Bordetella (the intranasal 6 month that includes Adenovirus, Parainfluenza, and Bordetella is highly recommended)

• DHLPP annual or equivalent (or puppy series)

• Rabies 1 year or 3 year (once old enough for puppies)

• *Highly Recommended:

Canine Influenza (H3N2 or H3N2/H3N8.

*These are not part of the regular vaccines routinely given and have to be
My dog has the following vaccinations up to date:

DHPP or equivalentBordetellaCanine InfluenzaRabies
Does your dog have any environmental allergies or skin conditions? Please be specific.*
If None, type None
Please upload a picture of your puppy

Cancelof
Is your puppy ALLERGIC to any of the following (or has stomach issues with)? We provide lick mats and/or Kongs during nap times and treats during exposure exercises:*

Peanut ButterChickenLambBeefFishBananasYogurtApplesauceCottage cheesePup-peroni treatsSweet potatoOatmealBlueberriesOther
Are there any places your dog does not like to be touched?*
If None, type None
Is your dog afraid of any of the following?*

ThunderstormsFireworksMost Loud NoisesWind/RainNoneOther
Does your dog have any problems in the following areas:*

MouthingJumping/Mounting other dogsNot house brokenBarkingChewing beddingDestroying toysEating rocks/foreign objectsHas sensitive pawsClimbing fencesIgnoring commandsOther
Is your dog crate trained? (crating is required for nap times)*

Yes, using every dayNo, have never triedYes, but it's been a whileBad in a crateHas accidents in crateUnknown
Does your dog use pee pads in the home?*

YesNo
Is your puppy potty trained*

YesNoHas accidents in the houseHas accidents in the crateWorking on it

How does your dog initially act in these situations:*

	Fearful	Submissive	Relaxed	Dominant	Don't know
Greeting a stranger in Public
Interacting with Veterinarian or Vet Tech
When a person reaches for your dog's collar or head
Being touched or approached with owner present
When hugged or lifted
When a person takes food, toys or prized objects
Interacting with other family dogs
Passing a calm dog on a leash
Passing an excited or barking dog on a leash
At a dog park or other social setting

What Enrichment items sound most appealing for us to provide for your puppy:*

Scent work puzzlesScent room (changes monthly)Scent gamesNature walks with sniffing gamesObstacle coursesWeaving thru poles"puppy" agilityFocus gamesName gamesManner gamestreadmill (low speed and short time period)
What Exposure items sound most appealing for us to provide for your puppy? We have a list of 101 socialization items that we start to use with your puppy, and we hope you can work on some from the list at home.*

Body handling (ears, tail, nose, teeth, collar, etc)Noises (vacuum, leaf blower, pots and pans, big trucks, rain/thunder, sirens, doorbells,etc)Items (umbrella, grocery bags, mops, brooms, etc)People (with hats, costumes, beards, hoodies, hats, skateboards, baby stroller,etc)
The manners training provided works on the following. Check all that you want your puppy to work on:*

Loose leash walkingNo pulling on the leashNo jumping on peopleFocus on youName recognitionOther
Please provide other comments or information about any training your dog has had:
Please provide other comments or information about your dog that you feel might be helpful:
Image Release*

I grant permission to post pictures of my dog(s) with their name on Ultimutt Knoxville website, on our public social media (Facebook, Instagram, etc.) and/or in other print and video/TV media related to Ultimutt Knoxville.I grant permission to post pictures of my dog(s) without their name on Ultimutt Knoxville website, on our public social media (Facebook, Instagram, etc.) and/or in other print and video/TV media related to Ultimutt Knoxville.
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Ultimutt Knoxville Preschool & Kindergarten Information

Medical History and Information