Off-Leash Play Application

Please submit one application for each dog whom you would like to enroll in off-leash play.

Date*
MM slash DD slash YYYY
Pet Parent Information
First Name*
Last Name*
Phone*
Pet Information
Dog's Name*
Why are you interested in our small group off-leash play program for your dog? (check all that apply)*
- So my dog can play with other dogs
- So my dog isn't left at home alone
- To give my dog a primary source of exercise
- To give my dog an additional source of exercise
- Recommended by pet professional (trainer or vet)
- Other
Please explain*
Does your dog exhibit symptoms of separation anxiety?*
- Yes
- Sometimes
- Never
Please explain.*
Please indicate behaviors your dog exhibits (check all that apply)
- Following handler excessively
- Pacing
- Excessive salivating
- Excessive shaking
- Vomiting
- Destructive chewing
- Excessive barking
- Howling
- Excessive whinning
- Urination, defecation in the house
- Self harm
- Digging and scratching at doors/windows
- Other
Please describe all other behaviors*
Which of the following best describes your dog's level of socialization with other dogs?*
- Extensive - regular visits to dog social events, off-leash dog parks, dog daycare, etc.
- Moderate - some off-leash playtime on occasion with visitor's / neighbor's / friend's dog(s)
- Minimal - on-leash encounters only
- None
Has your dog had any problems previously in an off-leash social environment?*
- Yes
- No
Please check all that apply*
- Altercation or fight at a public dog park
- Altercation or fight with a neighbor or friend's dog
- Fearful reaction in a group of dogs
- Dismissed from a prior dog daycare of social playgroup program?
- Other
Please describe "other" circumstances*
Please explain circumstances behind why your dog was dismissed from daycare/social playgroup program?*
Check each statement below that applies to the circumstances that resulted in your dog's dismissal*
- My dog was injured; no medical treatment required
- My dog was injured and required medical treatment
- 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 was injured and required medical treatment
Household and Behavior Information
Do any visitor's 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 house or yard?*
Does your dog ever bark or growl at anyone passing outside your house or yard?*
- Yes
- No
Please explain*
Are there any breeds of dogs your dog seems to fear or dislike?*
- Yes
- No
Please explain*
How does your dog react to puppies?
On Leash - how does your dog react to another dog approaching him / her in a park or on a walk?*
Off Leash - how does your dog react to another dog approaching him / her in a park or on a walk?*
Does your dog play with other dogs?*
- Yes
- No
Which types?*
- Male and females
- Males only
- Females only
Please describe the size, breed, and temperament of the other dogs.*
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?*
Are there any particular types of people your dog seems to fear or dislike?*
- Yes
- No
Please describe*
To the best of your knowledge, what does your dog do when you are not home?*
Please list any comments or other information about your dog that you feel may be helpful
K9 Club Care Agreement and Disclaimer
Participation in K9 Club's off-leash play program and boarding is voluntary. K9 Club reserves the right to excuse any dog from daycare or boarding at any time for negative behavior.

Dogs participating on our small-group off-leash play program will be supervised at all times. However, anytime groups of dogs play off-leash together, there is a chance for injury. By checking below, I'm giving permission for my dog to play off-leash with other dogs and play on agility equipment while in the K9 Club facility.

I understand that there are risks and benefits associated with group socialization of dogs. I agree that the benefits outweigh the risks and I accept the risks.

I desire a socialized environment for my dog while attending the services provided by K9 Club, and while my dog is in their care, I understand that while socialization and play are closely monitored by K9 Club staff to prevent injury, it is still possible that during the course of normal play my dog may receive minor injuries from roughhousing with other dogs.

I understand all pets have to pass a behavior evaluation prior to participating in our off-leash play environment. There is a $25 for this evaluation.
*
- By checking this box, I state that I have read and understand the conditions set forth in this Disclaimer and Agreement and that I agree to all conditions set forth herein.