DAYCARE INFORMATION FORM
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1 DAYCARE INFORMATION FORM BANDILANE CANINE CENTER Joyce Diamond, CPDT 80 Largo Drive, Stamford, CT ph: , fx: OWNER S NAME ADDRESS CITY/STATE/ZIP HOME PHONE WORK PHONE CELL PHONE ADDRESS EMERGENCY CONTACT FAX PHONE VETERINARIAN S NAME AND ADDRESS VET S PHONE VET S FAX VET S DOG S NAME BREED DATE OF BIRTH MALE FEMALE COLOR(S) WEIGHT NEUTERED/SPAYED? YES NO AGE DOG WAS NEUTERED/SPAYED? DOG S BACKGROUND? BREEDER PET SHOP ADOPTED/RESCUED OWNED SINCE: IF ADOPTED, PREVIOUS HISTORY FORMAL TRAINING? WHERE? WHAT LEVEL? WHAT COMMANDS DOES DOG KNOW? HOW DOES DOG REACT ON-LEASH TO DOGS S/HE MAY NOT KNOW? DOES DOG PLAY WITH DOGS OFF-LEASH? YES NO DESCRIBE WHEN, WHERE, FREQUENCY: HOW DOES DOG GREET PEOPLE? HAS DOG EVER BEEN AFRAID OF ANY PERSON? YES NO DESCRIBE: HAS DOG EVER GROWLED AT ANYONE? NO YES HAS DOG EVER BITTEN? NO YES IF ANSWERED YES, PLEASE DESCRIBE: HAS DOG EVER GROWLED/SNAPPED WHEN TAKING AWAY FOOD OR TOY? NO YES IS DOG IN GOOD HEALTH? YES NO ON ANY MEDICATION? NO YES MEDICATION: REASON FOR MEDICATION: DOES DOG HAVE ANY PHYSICAL PROBLEMS? ELBOW OR HIP DYSPLASIA ALLERGIES RESTRICTIONS ON ACTIVITIES? HOW DOES DOG REACT TO BEING BRUSHED? NAILS TRIMMED? IS THERE ANYWHERE ON DOG S BODY THAT S/HE DOES NOT LIKE TO BE TOUCHED? PHRASE YOUR DOG UNDERSTANDS TO GO TO THE BATHROOM:
2 Dog s Name Owner s Name Date Dog Personality Profile Questionnaire The purpose of this questionnaire is to collect information about your dog s personality. We will be asking you questions about your dog s behavior which will help us identify the dog s personality. There are no right or wrong, or good or bad answers. Instinctive Behavior Dogs natural behaviors are called instinctive behaviors and are inherited from their ancestors. Instinctive behaviors are grouped into three categories: prey (chase), pack (social interaction), and defense (self preservation). Knowing your dog s personality helps us to train and socialize your dog effectively in our daycare program. Directions: Read each statement. Think about what your dog would do in each situation. Think about how your dog would behave if you hadn t trained her not to or to behave in a certain way (remember instinctive behavior) For example, asked if your dog would steal food from the counter, she might not because you trained her not to jump on the counter. But, if you hadn t trained her, would she steal food from the counter? Then refer to the rating scale on the top of each page. Determine the number (1-7) which most accurately describes your dog s behavior in each situation. Place the number in the space next to each statement. Example: RATING SCALE steal food from the kitchen counter?
3 RATING SCALE Identifying Prey Drive (Chase) 1. sniff the ground or air? 2. stalk, point, or freeze before chasing cats, dogs or other moving things? 3. vocalize with high pitched barks when excited or during play? 4. pounce and shake and kill his toys? 5. like to carry objects? 6. dig holes (real or imaginary) 7. chase kids playing 8. bury things 9. play ball forever 10. play tug-of-war Prey (Chase) Drive Score: Max Prey (Chase) Drive Score Possible: 70 Identifying Prey Food Drive 1, inhale his food and look for more? 2. beg for food? 3. anticipate feeding time and beat you to the kitchen? 4. eat any time, any place and in any circumstance? 5. steal food at any opportunity? 6. take any opportunity to have a snack? Prey Food Drive Score: Max Prey Food Drive Score Possible: 42 Total Prey Drive Score: Chase + Food = Total Prey Drive
4 RATING SCALE Identifying Pack Drive - Dog Pack 1, get along with other dogs? 2, play with any dog at any time? 3, whine and pull to get to another dog? 4, interact with another dog when approached 5, ignore other dogs? 6, initiate interaction with other dogs? 7, fight with other dogs? 8, show that he s very wary of other dogs? 9, mount other dogs Dog Pack Score: Max Dog Pack Score Possible: 63 People Pack 1, jump up to greet people? 2, want to be petted all the time? 3, enjoy being brushed? 4, seek eye contact with you? 5, bark when left alone? 6, follow you from room to room? 7, bark at you to get attention? 8, love everybody he meets right away? 9, lie close to you and want to be where you are? People Pack Score: Max People Pack Score Possible: 63 Total Pack Score: Dog + People = Total Pack
5 RATING SCALE Identifying Defense Drive: Fight and Flight behaviors Fight 1, stand his ground or go forward to investigate strange objects or sounds? 2, play tug of war games to win? 3, bark in deep tones or belly growl? 4, guard his territory (crate, kennel, run, yard etc) 5, guard his owners? 6, guard food or toys? 7, dislike or avoid being groomed or bathed? 8, come into an area with dogs confidently? 9, like to fight with other dogs? 10, stand rigid, ears forward and head held high when another dog approaches? Fight Score: Max Fight Score Possible: 70 Flight 1, keep away or run away from new situations or loud noises? 2, hide behind you, run away or urinate upon meeting a stranger? 3, act fearful in unfamiliar places? 4, tremble or whine when unsure? 5, sleep on the floor or some location lower than your sleeping place? 6, reluctant to come close to you when called? 7, crawl on belly or turn upside down when verbally scolded? 8, have difficulty standing still while being groomed? 9, wait for you to initiate petting? 10, show a tendency to bite when cornered? Flight Score: Max Flight Score Possible: 70 Score Summary: High Score = Strong Drive Prey Drive: (Chasing Food ) Pack Drive: (Dog People ) Defense - Fight: Defense - Flight:
6 Bandilane Daycare Waiver and Agreement I,, hereby certify that my dog(s) is/are in good health and has/have not been ill with any communicable condition in the last 30 days. I further certify that my dog(s) has/have not harmed or shown aggressive or threatening behavior towards any person or any other dog. I further understand and agree that in admitting my dog(s) to Bandilane School for Dogs, Inc. Doggie Daycare Center, the Bandilane staff have relied on my representation that my dog(s) is/are in good health and have not harmed or shown aggressive or threatening behavior towards any person or any other dog. I agree to provide valid proof of all required vaccinations (Rabies, Distemper, Parvovirus, Bordetella) and a negative fecal exam. I will provide a negative fecal exam every year thereafter and I will provide current vaccination records when vaccinations are updated. I understand that participation in the Doggie Daycare Center at Bandilane School for Dogs, Inc. is not without some risk, that despite all the dogs appearing healthy and being handled with the greatest amount of care and foresight, dogs are not always predictable and the unexpected may occur. I hereby waive and release Bandilane School for Dogs, Inc., its employees, owners and agents from any and all claims, while on the grounds or the surrounding area thereto, and resulting from participation in any activity at Bandilane School for Dogs, Inc. including specifically, but without limitation, any injury or damage resulting to me or my dog(s), or to or from the action of any dog(s), including my own. I understand that I am solely responsible for any harm caused by my dog(s) while my dog(s) is/are attending Bandilane School for Dogs, Inc. Doggie Daycare Center. I further understand and agree that any problems which develop with my dog(s) will be treated as deemed best by the staff of Bandilane School for Dogs, Inc. If medical attention is needed Bandilane School for Dogs, Inc. will make every effort to contact me or my emergency contact. If I am unavailable, I give Bandilane School for Dogs, Inc. permission to seek veterinary care at the veterinarian of their choice. I agree to assume full financial responsibility for any and all expenses involved. I further agree not to hold Bandilane School for Dogs, Inc. responsible if they fail to seek veterinary care. I further agree that my dog may be videotaped, photographed, photographed and/or recorded. Days, Hours, Fees: Open Monday through Friday from 6:30 AM to 6:30 PM. There is a $.50 per minute charge for any dog left after 6:30 PM. Discount passes are non-refundable. Days, hours and prices are subject to change without notice. I understand and agree to the above conditions. Signature Date
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Off-Leash Play Application
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Owner/Guardian Information Daycare & Boarding Application Name: Date Address: City/State/Zip: E-mail Address: Home # Work # Cell # Place of Employment: Emergency Contact: (Required-not in the same residence)
Playcare, Boarding, & Dog Walking Application
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Mile High Weimaraner Rescue Surrender Packet
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Guest Profile. Owner s Information. Pet s Information. Emergency Contact: General:
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INCOMING CAT PROFILE
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Feline Distemper (FVRCP) Parvovirus. In order for your pet to play in our daycare groups he/she must be neutered/spayed if over 9 months of age.
Boarding Registration Daycare Registration Thank you for choosing Just For Paws Pet Spa to care for your pet while you re away. Here is some helpful information regarding our requirements for boarding
DOGGY DAYCARE CONTRACT
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