Off-Leash Play Application Please submit one application for each dog whom you would like to enroll in off-leash play. Date* Date Format: MM slash DD slash YYYY Pet Parent InformationFirst Name*Last Name*Phone*Pet InformationDog'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?*YesSometimesNeverPlease 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 onlyNoneHas your dog had any problems previously in an off-leash social environment?*YesNoPlease 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 InformationDo any visitor's bring their dog(s) to your house?*YesNoHow 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?*YesNoPlease explain*Are there any breeds of dogs your dog seems to fear or dislike?*YesNoPlease 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?*YesNoWhich 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?*YesNoHow 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?*YesNoPlease 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 helpfulK9 Club Care Agreement and DisclaimerParticipation 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. * 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.