Off-Leash Play Application "*" indicates required fields We love dogs and want your dog to love coming to our off-leash playgroup. No one knows your dog better than you, so we’d appreciate you taking the time to fill out this application. The more we know about the dogs in our care, the better our playgroups will be. Rock On. Please submit one application for each dog who you would like to have in off-leash play. Owner’s Information Owner’s Name* First Last Owner Name 2 First Last Address* Street Address City State ZIP Email* Phone*Dog’s InformationDog’s Name*Breed*If a mix, list two predominant breeds.Weight*Dog’s Date of Birth* Month Day Year How long have you owned your dog?*Is your dog spayed/neutered?*BnR’s general policy is that all dogs attending our group social programs must be spayed or neutered before or at 7 months of age. Yes No If your dog is not spayed/neutered please give details on any spay/neuter plan and timeframe.Where did you get your dog?*Choose oneAnimal rescue groupAnimal shelterBreederFound as strayFriendNewspaper adPet storeOtherPlease specify where you got your dog.*What knowledge do you have of your dog’s past history?*Why are you considering our off-leash dog play program for your dog?*Check all that apply To play with other dogs So not home alone For primary source of exercise For additional source of exercise Recommended by other pet professional (trainer, vet…) Other Please explain reason for recommendation.*Please explain why you are considering this program.*Does your dog exhibit symptoms of separation anxiety?* Yes No Which of the following best describes your dog’s level socialization with other dogs:* None – No knowledge of other dog interaction. Minimal – On leash encounters only Moderate – Some off-leash playtime on occasion with visitor’s/neighbor’s/friend’s dog(s) Extensive – Regular visits to dog social events, off-leash dog parks, dog daycare, etc. Has your dog had any problems previously in an off-leash social environment?* Yes No What reason were you given as to why your dog was dismissed?*Include any other comments you want us to know about this situation.Check each statement below that applies to the situation that resulted in your dog’s dismissal.* My dog was injured, no medical treatment required Another dog was injured, no medical treatment required Another dog was injured and required medical treatment A person was injured, no medical treatment required A person injured and required medical treatment Health HistoryPlease describe your dog’s flea/tick control and prevention program.*Does your dog have any allergies?* Yes No Please explain allergies.*Does your dog have any physical disabilities?* Yes No Please explain disability and cause.*What restrictions need to be placed on your dog’s activities or movements?* No jumping No running No hard play No contact with other dogs Other Please explain restrictions.*Does your dog have any medical conditions?* Yes No Please explain medical condition(s).*Is your dog taking any medication(s) to control the condtion?* Yes No Please provide medication name and dosage.*Eating, Sleeping, GroomingWhat type of food does your dog eat?*Check all that apply. Kibble / Dry Canned Home cooked Raw Semi moist What brand?* (Innova, Iams, Purina, etc.)What is the primary source of protein?*(fish, chicken, beef, etc.)Please outline your feeding schedule.*On what type of surface does your dog generally go to the bathroom ?*(grass, mulch, pee pads, etc.)Does your dog have any bathroom-related issues or concerns?* Yes No Please explain issues and/or concerns.*How often do you brush or comb your dog’s coat?*How does your dog react to having his/her nails clipped?*Does your dog like to be brushed?* Yes No What have you tried to make brushing more enjoyable?*Does your dog have any sensitive areas on his/her body?* Yes No Where?*Where are your dog’s favorite petting spots?*How frequently is your dog walked outside?*Where does your dog sleep?* Inside the house Outside the house Both — it varies In which room in the house does your dog sleep?*Where in the room does your dog sleep?* Crate Owner’s bed Dog cushion/Bed on floor Other Please describe where your dog sleeps.*How long are your walks?*Check off one below which best represents your dog’s overall level of exercise routine:* Couch Potato: Spends days sleeping, occasional walks and/or playtime with humans or other dogs. Mild Exerciser: Short daily walks and/or regular playtime with human or other dogs. Moderate Exerciser: Long or multiple walks daily and/or regular playtime with human or dogs. Athlete: Regular jogs/runs and/or participation in a dog sport activity such as agility, flyball, frisbee, etc. Household InformationDo you have other pets in the household?* No other pets Other dog(s) Cat(s) How many other dogs?*Choose one12345Breed:*Age:*Sex:* Male Female Is he neutered?* Yes No Is she spayed?* Yes No Breed:*Age:*Sex:* Male Female Is he neutered?* Yes No Is she spayed?* Yes No Breed:*Age:*Sex:* Male Female Is he neutered?* Yes No Is she spayed?* Yes No Breed:*Age:*Sex:* Male Female Is he neutered?* Yes No Is she spayed?* Yes No Breed:*Age:*Sex:* Male Female Is he neutered?* Yes No Is she spayed?* Yes No How many cats do you have?*Choose one1234 or moreHow does your dog get along with your cat(s)?*Describe how your dog gets along with your other household pet(s)?*Behaviors and InteractionsDoes your dog like children?* Yes No How does your dog behave around children?*Do any visitors bring their dog(s) to your house?* Yes No How do they get along?*How does your dog react to a stranger coming into your home or yard?*Does your dog ever bark or growl at anyone passing outside your home or yard?* Yes No Please explain.*Has your dog ever jumped up on someone?* Yes No What were the circumstances?*Are there any types and/or breeds of dogs your dog seems to automatically fear or dislike?* Yes No Please explain.*How does your dog react to puppies?*How does your dog react to another dog approaching him/her in a park, at the beach, or on a walk?*When on leash:When off leash:*When off leash:Does your dog play with other dogs?* Yes No Which type?* Only males Only females Both males and females Please describe size, breed, temperament of other dogs.*sizebreedtemperament Add RemoveDoes your dog have any previous daycare or boarding experience? If so, where? For how long? And why did you stop using that service?*How does your dog get along with cats?*How does your dog react to unfamiliar cats when on walks?*What kind of games does your dog play with other dogs?*What kind of games does your dog play with people?*Has your dog ever shared his/her food or toys with other animals?* Yes No How does your dog react to another dog approaching his/her food or toys?*Which commands does your dog know?*Please check all that apply. Sit Stay Down Come Heel Rollover Kisses High Five Other Please specify other commands.*How did your dog get his/her obedience training?*Please check all that apply. Attended one group class Attended more than one level of group classes Dog was sent to a board and train program Private sessions in home Other Please explain.*Which of the following best describes the use of obedience cues with your dog at home?* Key part of daily communication Used when we go on walks or have people over Used occasionally to better control behavior Rarely used Not applicable What kind of a collar(s) do you use to walk your dog?*Please check all that apply Buckle Nylon / Chain choke collar Harness — leash clips on front Harness — leash clips on back Head collar Prong / Pinch Martingale Other Please specify collar.*Is it effective in keeping him/her under control?* Yes No Has your dog ever gotten away from someone when out for a walk?* Yes No Please explain circumstances.*How does your dog act when you get home at the end of the day?*What does your dog do to show he/she is happy?*What does your dog do to show he/she is upset?*Is your dog allowed on the furniture at home?* Yes No Does your dog have any problems in any of the following areas?* Mouthing House-training Barking Digging Ignoring commands None of the above Please explain problems with mouthing.*Please explain problems with house-training.*Please explain problems with barking.*Please explain problems with digging.*Please explain problems with ignoring commands.*Does your dog know any tricks?* Yes No Please describe your dog’s tricks.*Are there any particular types of people your dog seems to automatically fear or dislike?* Yes No Please explain.*Has your dog ever growled at someone?* Yes No What were the circumstances and how did you respond?*Has your dog ever bitten a person?* Yes No What were the circumstances and how did you respond?*If there were any injuries, please describe.Has your dog ever bitten another animal?* Yes No What were the circumstances and how did you respond?*If there were any injuries, please describe.To the best of your knowledge, what does your dog do when you’re not at home?*Has your dog ever climbed/jumped a fence?* Yes No What were the circumstances? How high was the fence?*Has your dog ever escaped from your house or yard?* Yes No Please explain the circumstances.*How would you describe the energy level of your dog?* Low Medium High Has your dog ever chased or tried to chase a small animal?* Yes No Please explain the circumstances.*Has your dog ever chased someone (or wanted to) on a skateboard or bicycle?* Yes No What were the circumstances.*Is your dog frightened by thunderstorms?* Yes No Describe typical behavior and what specifically helps to relax your dog or calm his/her fear.*Is your dog frightened or nervous around anything else?* Yes No Please explain.*Does your dog play with any toys?* Yes No What kinds of toys does your dog like?*Has your dog ever growled or snapped at a person who has taken food or toys away from him/her?* Yes No What were the circumstances and how did you respond?*Has your dog ever growled or snapped at another dog who has taken food or toys away from him/her?* Yes No What were the circumstances and how did you respond?*Have you ever noticed your dog stopping and staring at another animal?* Yes No What were the circumstances?*Has your dog ever been crated?* Yes No What is your dog’s level of comfort in a crate/ enclosure?*Do you have any comments or information about your dog that you feel might be helpful to us?How did you hear about us?Would you like us to send you information on our services? Daycare Walking Boarding Sitting Overnight Sitting Private Training Group Classes Untitled "*" indicates required fields We love dogs and want your dog to love coming to our off-leash playgroup. No one knows your dog better than you, so we’d appreciate you taking the time to fill out this application. The more we know about the dogs in our care, the better our playgroups will be. Rock On. Please submit one application for each dog who you would like to have in off-leash play. Owner’s Information Owner’s Name* First Last Owner Name 2 First Last Address* Street Address City State ZIP Email* Phone*Dog’s InformationDog’s Name*Breed*If a mix, list two predominant breeds.Weight*Dog’s Date of Birth* Month Day Year How long have you owned your dog?*Is your dog spayed/neutered?*BnR’s general policy is that all dogs attending our group social programs must be spayed or neutered before or at 7 months of age. Yes No If your dog is not spayed/neutered please give details on any spay/neuter plan and timeframe.Where did you get your dog?*Choose oneAnimal rescue groupAnimal shelterBreederFound as strayFriendNewspaper adPet storeOtherPlease specify where you got your dog.*What knowledge do you have of your dog’s past history?*Why are you considering our off-leash dog play program for your dog?*Check all that apply To play with other dogs So not home alone For primary source of exercise For additional source of exercise Recommended by other pet professional (trainer, vet…) Other Please explain reason for recommendation.*Please explain why you are considering this program.*Does your dog exhibit symptoms of separation anxiety?* Yes No Which of the following best describes your dog’s level socialization with other dogs:* None – No knowledge of other dog interaction. Minimal – On leash encounters only Moderate – Some off-leash playtime on occasion with visitor’s/neighbor’s/friend’s dog(s) Extensive – Regular visits to dog social events, off-leash dog parks, dog daycare, etc. Has your dog had any problems previously in an off-leash social environment?* Yes No What reason were you given as to why your dog was dismissed?*Include any other comments you want us to know about this situation.Check each statement below that applies to the situation that resulted in your dog’s dismissal.* My dog was injured, no medical treatment required Another dog was injured, no medical treatment required Another dog was injured and required medical treatment A person was injured, no medical treatment required A person injured and required medical treatment Health HistoryPlease describe your dog’s flea/tick control and prevention program.*Does your dog have any allergies?* Yes No Please explain allergies.*Does your dog have any physical disabilities?* Yes No Please explain disability and cause.*What restrictions need to be placed on your dog’s activities or movements?* No jumping No running No hard play No contact with other dogs Other Please explain restrictions.*Does your dog have any medical conditions?* Yes No Please explain medical condition(s).*Is your dog taking any medication(s) to control the condtion?* Yes No Please provide medication name and dosage.*Eating, Sleeping, GroomingWhat type of food does your dog eat?*Check all that apply. Kibble / Dry Canned Home cooked Raw Semi moist What brand?* (Innova, Iams, Purina, etc.)What is the primary source of protein?*(fish, chicken, beef, etc.)Please outline your feeding schedule.*On what type of surface does your dog generally go to the bathroom ?*(grass, mulch, pee pads, etc.)Does your dog have any bathroom-related issues or concerns?* Yes No Please explain issues and/or concerns.*How often do you brush or comb your dog’s coat?*How does your dog react to having his/her nails clipped?*Does your dog like to be brushed?* Yes No What have you tried to make brushing more enjoyable?*Does your dog have any sensitive areas on his/her body?* Yes No Where?*Where are your dog’s favorite petting spots?*How frequently is your dog walked outside?*Where does your dog sleep?* Inside the house Outside the house Both — it varies In which room in the house does your dog sleep?*Where in the room does your dog sleep?* Crate Owner’s bed Dog cushion/Bed on floor Other Please describe where your dog sleeps.*How long are your walks?*Check off one below which best represents your dog’s overall level of exercise routine:* Couch Potato: Spends days sleeping, occasional walks and/or playtime with humans or other dogs. Mild Exerciser: Short daily walks and/or regular playtime with human or other dogs. Moderate Exerciser: Long or multiple walks daily and/or regular playtime with human or dogs. Athlete: Regular jogs/runs and/or participation in a dog sport activity such as agility, flyball, frisbee, etc. Household InformationDo you have other pets in the household?* No other pets Other dog(s) Cat(s) How many other dogs?*Choose one12345Breed:*Age:*Sex:* Male Female Is he neutered?* Yes No Is she spayed?* Yes No Breed:*Age:*Sex:* Male Female Is he neutered?* Yes No Is she spayed?* Yes No Breed:*Age:*Sex:* Male Female Is he neutered?* Yes No Is she spayed?* Yes No Breed:*Age:*Sex:* Male Female Is he neutered?* Yes No Is she spayed?* Yes No Breed:*Age:*Sex:* Male Female Is he neutered?* Yes No Is she spayed?* Yes No How many cats do you have?*Choose one1234 or moreHow does your dog get along with your cat(s)?*Describe how your dog gets along with your other household pet(s)?*Behaviors and InteractionsDoes your dog like children?* Yes No How does your dog behave around children?*Do any visitors bring their dog(s) to your house?* Yes No How do they get along?*How does your dog react to a stranger coming into your home or yard?*Does your dog ever bark or growl at anyone passing outside your home or yard?* Yes No Please explain.*Has your dog ever jumped up on someone?* Yes No What were the circumstances?*Are there any types and/or breeds of dogs your dog seems to automatically fear or dislike?* Yes No Please explain.*How does your dog react to puppies?*How does your dog react to another dog approaching him/her in a park, at the beach, or on a walk?*When on leash:When off leash:*When off leash:Does your dog play with other dogs?* Yes No Which type?* Only males Only females Both males and females Please describe size, breed, temperament of other dogs.*sizebreedtemperament Add RemoveDoes your dog have any previous daycare or boarding experience? If so, where? For how long? And why did you stop using that service?*How does your dog get along with cats?*How does your dog react to unfamiliar cats when on walks?*What kind of games does your dog play with other dogs?*What kind of games does your dog play with people?*Has your dog ever shared his/her food or toys with other animals?* Yes No How does your dog react to another dog approaching his/her food or toys?*Which commands does your dog know?*Please check all that apply. Sit Stay Down Come Heel Rollover Kisses High Five Other Please specify other commands.*How did your dog get his/her obedience training?*Please check all that apply. Attended one group class Attended more than one level of group classes Dog was sent to a board and train program Private sessions in home Other Please explain.*Which of the following best describes the use of obedience cues with your dog at home?* Key part of daily communication Used when we go on walks or have people over Used occasionally to better control behavior Rarely used Not applicable What kind of a collar(s) do you use to walk your dog?*Please check all that apply Buckle Nylon / Chain choke collar Harness — leash clips on front Harness — leash clips on back Head collar Prong / Pinch Martingale Other Please specify collar.*Is it effective in keeping him/her under control?* Yes No Has your dog ever gotten away from someone when out for a walk?* Yes No Please explain circumstances.*How does your dog act when you get home at the end of the day?*What does your dog do to show he/she is happy?*What does your dog do to show he/she is upset?*Is your dog allowed on the furniture at home?* Yes No Does your dog have any problems in any of the following areas?* Mouthing House-training Barking Digging Ignoring commands None of the above Please explain problems with mouthing.*Please explain problems with house-training.*Please explain problems with barking.*Please explain problems with digging.*Please explain problems with ignoring commands.*Does your dog know any tricks?* Yes No Please describe your dog’s tricks.*Are there any particular types of people your dog seems to automatically fear or dislike?* Yes No Please explain.*Has your dog ever growled at someone?* Yes No What were the circumstances and how did you respond?*Has your dog ever bitten a person?* Yes No What were the circumstances and how did you respond?*If there were any injuries, please describe.Has your dog ever bitten another animal?* Yes No What were the circumstances and how did you respond?*If there were any injuries, please describe.To the best of your knowledge, what does your dog do when you’re not at home?*Has your dog ever climbed/jumped a fence?* Yes No What were the circumstances? How high was the fence?*Has your dog ever escaped from your house or yard?* Yes No Please explain the circumstances.*How would you describe the energy level of your dog?* Low Medium High Has your dog ever chased or tried to chase a small animal?* Yes No Please explain the circumstances.*Has your dog ever chased someone (or wanted to) on a skateboard or bicycle?* Yes No What were the circumstances.*Is your dog frightened by thunderstorms?* Yes No Describe typical behavior and what specifically helps to relax your dog or calm his/her fear.*Is your dog frightened or nervous around anything else?* Yes No Please explain.*Does your dog play with any toys?* Yes No What kinds of toys does your dog like?*Has your dog ever growled or snapped at a person who has taken food or toys away from him/her?* Yes No What were the circumstances and how did you respond?*Has your dog ever growled or snapped at another dog who has taken food or toys away from him/her?* Yes No What were the circumstances and how did you respond?*Have you ever noticed your dog stopping and staring at another animal?* Yes No What were the circumstances?*Has your dog ever been crated?* Yes No What is your dog’s level of comfort in a crate/ enclosure?*Do you have any comments or information about your dog that you feel might be helpful to us?How did you hear about us?Would you like us to send you information on our services? Daycare Walking Boarding Sitting Overnight Sitting Private Training Group Classes Untitled