Application – The Canine Club

Dog's Information

Dog's Name

Dog's Age

Dog's Birthday

Dog's Breed

Dog’s Approximate Weight (in pounds)

Dog's Color/Patterns

Gender

Spayed/Neutered?

Pet Parent Information

Parent 1 Name

First Last

Parent 1 Email

Parent 1 Cell Phone

Parent 2 Name

First Last

Parent 2 Email

Parent 2 Cell Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Emergency Contact Name

First Last

Emergency Contact Phone

Who else is authorized to pick up your dog?

Veterinarian Information

Vet Clinic Name

Vet Clinic Phone

Vet Clinic Email

Vet Clinic Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Proof of Required Vaccinations

Rabies

Distemper

Leptospirosis

Bordetella

K9 Influenza

Please Upload Vaccination Records

Drop files here or

Max. file size: 128 MB, Max. files: 10.

Health Information

Allergies

Issues we need to be aware of?

Physical Limitations

Is your dog permitted to have a Nylabone while in the crate when at daycare?

Yes

No

Rate your dogs level of exercise/activity (playing, running) on a daily basis.

Pet Personality Profile

How long have you owned your dog?

Age when Spayed/Neutered

Where did you get your dog?

If adopted, describe your knowledge of your dog’s past history.

Number of Adults in Household

Number of Children in Household

How does your dog behave around children?

What other animals are in your house?

How does your dog act with these animals?

Grooming History

How often is your dog groomed?

Professional or At-Home?

Dog's Reaction to Grooming

Do you use flea/tick treatment? If so, what kind?*

Pet General Behavior

Do visitors bring their dogs to your home?

How does your dog react?

How does your dog react to strangers in your home?

How does your dog react to dogs of various sizes?

Does your dog automatically fear or dislike particular types of dogs?

How does your dog react to puppies?

How does your dog react to another dog approaching him/her when you are out on a walk?

Has your dog ever attempted to bite someone?

How does your dog handle being left alone?

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

How does your dog show he/she is happy?

Has your dog ever climbed or jumped over a fence?

Does your dog have any challenges in the following areas? Mouthing, Housetraining, Barking, Digging, Ignoring commands.

What kind of noises frighten your dog?

What other things frighten or make your dog nervous?

Does your dog growl or snap when food or toys are taken away?

Has your dog ever shared food or toys with other animals?

Does your dog play with toys?

Does your dog like to play with other dogs?

What kind of dogs does your dog like to play with?

Have you taken your dog to the dog park? If so, how do they do?

Pet Communication/Training

Is your dog crate trained?

Has your dog ever had any canine education (obedience) training?

If yes, when and where?

What commands does your dog know?

What hand signals do your dog know?

Does your dog have a “release” word?

Does your dog have a “quiet” command?

Does your dog have potty “cue”?

How often does your dog usually eliminate daily? At what times?

Other

Please add any other comments or information that you feel might be helpful to us in the evaluation process.

How did you hear about The Canine Club?

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Email

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Dog's Information

Pet Parent Information

Veterinarian Information

Pre-Screening Questions

Health Information

Pet Personality Profile

Grooming History

Pet General Behavior

Pet Communication/Training

Other

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