Mailchimp Survey

Trailblazers Playgroup Application Form

Prerequisites:
All dogs must be up to date on their vaccinations and
All dogs must be altered (neutered/spayed) - 6 months and older
Please fill out one application form per dog.
YOUR INFORMATION
Please provide contact information for primary walker and secondary walker
First and Last Name of Primary Walker
*
First and Last Name of Secondary Walker - indicate N/A if this does not apply to you
*
Are you and the secondary walker both 18yrs or over?
*
YesNo
Emails
*
Cell Numbers
*
Home Number
Emergency Contact
*
Emergency Contact Number
*
DOG INFORMATION
Dog’s Name
*
Breed
*
Dog’s Weight - please indicate pounds or kg
*
Date of Birth: MM/DD/YYYY If you are unsure please indicate appx. year of birth.
*
Date of Last Vet Visit: MM/DD/YYYY
*
Vaccine Status - please provide with application
*
DAPP
Rabies
Bordetella
Describe Any Current or Previous Health Concerns
*
Reproductive Status
*
Intact MaleIntact FemaleNeutered MaleSpayed Female
DOG BEHAVIOUR HISTORY
Tell us about your dog’s behaviour history
*
Has your dog ever bitten a human with enough pressure to see toothmarks or punctures? If yes, please explain
*
Has your dog ever bitten another dog with enough pressure to see a puncture, or blood or to need stitches? If yes, please explain
*
Has your dog been to a public off-leash dog park in the past?
*
YesNo
If yes, did your dog experience any altercations with another dog at the public off-leash dog park?
YesNo
If yes, describe what happened
What does your dog usually do when they meet a new person away from your home?
*
Barks, growls, show teeth
Approaches them with a looses relaxed face and body
Jumps up on them
Cowers, tucks tail, raises a paw
Ignores them
Stares at them
Unknown - never met a new person away from our home
Other
What does your dog usually do when they meet a new dog away from your home?
*
Barks, growls, shows teeth
Approaches them with a loose relaxed face and body
Jumps up on them
Cowers, tucks tail, raises a paw
Ignores them
Stares at them
Unknown - never met a new dog away from our home
TRAINING HISTORY
Tell us about your dog’s training history
*
Does your dog have a Canine Good Neighbour Certification?
*
YesNo
Has your dog been rejected at any Doggie Daycare?
*
YesNo
If you answered yes, please explain why the daycare rejected your dog. If you answered no, type in N/A.
*
When you recall your dog at home, how often does your dog come to you?
*
AlwaysMost of the time - 7-9 x out of 10Sometimes - 4-6 x out of 10Rarely - 1-3 x out of 10Never
When you recall your dog at a park or other higher distraction locations, how often does your dog come to you?
*
AlwaysMost of the time - 7-9 x out of 10Sometimes - 4-6 x out of 10Rarely - 1-3 x out of 10Never
DOG’S PLAYSTYLE
Using the scale below, rank your dog’s favorite playstyle with 0 being definitely not my dog, and where 10 being his favorite playstyle. If your dog only fits into one group, it’s ok to select 0 for the remaining groups
My dog LOVES to run!! He enjoys the game of chase.
*
012345678910
My dog prefers to be on the outside of the group barking and running along side them without getting in the middle of the group of dogs.
*
012345678910
My dog loves full body contact. He loves to play wrestle with other dogs by gently mouthing their neck, face and ears.
*
012345678910
My dog loves to body slam other dogs and try to knock them over while playing.
*
012345678910
My dog does NOT like physical contact. My dog prefers to either be alone or run alongside another dog while maintaining space between each other.
*
012345678910
PET PARENTS TOLERANCE
On a scale from 1 - 5, where 5 means “I Strongly Agree” and 1 means “I Strongly Disagree”, please tell us your feelings about the following statements:
Dogs Sometimes have disagreements and scuffles
*
12345
A growling dog always means they are aggressive
*
12345
Some dog breeds are inherently vicious
*
12345
My dog would never bite anyone under any circumstance.
*
12345
I like to watch dogs wrestle, run and chase each other
*
12345