Emergency Contact Name and Phone Number - This is in case we cannot reach you - please do not provide your own contact information.

Dogs Name and Breed *

Sex

Male
Female

Spayed/Neutered? *

Yes
No

Vet Clinic you belong to, and contact number *

Dogs Age *

Is your dog up date on vaccinations (Rabies, Distemper, Parvovirus up to date, Bordetella within the last 12 months) *

Yes
No

Does your dog have any allergies? If yes, please provide details *

Has your dog attended daycare? If so, where, and what was the frequency and/or length of time? *

How long have you had your dog and at what age did you acquire him/her? *

Are there other animals in your house and how does your dog get along with them? *

List all formal training you have done with your dog and the trainer/company that did the training (Ex: Puppy classes, obedience classes, sport training, private training, etc.) *

Please describe your dog's overall temperament *

How does your dog behave on leash? (are they friendly with dogs and people while on leash) *

Has your dog ever growled at or bit a dog or person? *

Is there any situation your dog is uncomfortable with (types of people, situations, certain dogs or play styles, objects?) *

Can you take a food item or toy away from your dog willingly? *

Does your dog share toys with other dogs? *

Has your dog ever jumped a large fence or barrier before?

Is your dog on any current medication and do you require us to administer it?

Yes
No

Are there areas of your dog’s body they do not like to be touched? *

Has your dog ever socialized with a large group of dogs (6 or more)? How often does your dog socialize with groups of dogs? *

Do you attend off leash dog parks? *

Does your dog play well with dogs of all sizes? *

Do you have any special feeding instructions? *

Is there anything else specifically we should know about your dog?

Do you carry pet insurance? *

Yes
No

Please type yes to agree that you have read the Waiver and Liability Agreement *

Dog Daycare Assessment Form

Thanks for getting in touch!

Thanks for getting in touch!

Med Scrumplez Bunny

Med Scrumplez Bunny