E-Mail Address (required) : Name of Dog: (required) Gender: (required) Male FemaleAge of Dog: (required) Breed: (required) How long have you owned your dog? (required) Altered? (required) (* All pets over 6 months of age are required to be spayed or neutered in order to participate in daycare.) Yes NoMedical History
Does your dog have any past or current medical issues or injuries we need to be aware of? (required) Yes NoIf yes, please explain. Is your dog current on age appropriate vaccinations? (required) (* To attend daycare your dog must be current on Rabies, DAPP, and Bordetella vaccines.) Yes NoIf you are not a veterinary patient of Heart of Ankeny please list your veterinarian. (required) Is your dog current on flea/tick and heartworm prevention? (required) (*to attend daycare it is required that your dog is current on flea/tick prevention.) Yes NoIf yes, please list what products you are currently using. Does your dog have any allergies or dietary restrictions? (required) Yes NoIf yes, please explain. Training History
Has your dog attended any training or obedience classes? (required) Yes NoIf yes, please list classes/training attended below. What commands does your dog know and respond to? (required) Do you use and electronic fence or bark collar for your dog? (required) Yes NoIf yes, please explain. Social History
Describe your dog's energy level. (required) Low Medium HighHas your dog ever bitten or been aggressive with a person? (i.e. groomer, vet, strangers) (required) Yes NoIf yes, please explain. Has your dog ever shown aggressive behavior towards another dog? (required) Yes NoIf yes, please explain. Has your dog ever been in a situation with another dog that resulted in a bite wound to either dog? (required) Yes NoIf yes, please explain. Does your dog have issues with loud noises or thunderstorms? (required) Yes NoDoes your dog exhibit destructive behavior when left alone? (required) Yes NoDoes your dog willingly accept handling by others? (i.e. grooming, nail trims, etc.) (required) Yes NoIs there anything your dog is scared of? Please list below and explain how you handle it (required) Please list some of your dog's favorite activities. (required) Has your dog ever jumped a fence or gate higher than 4 feet? (required) (If yes, please list training completed.) Yes NoDoes (or has) your dog shown signs of resource guarding? (toys, objects, people, etc.) (required) Yes NoIf yes, please explain. Has your dog been to an off leash park? (required) Yes NoDoes your dog get along with other dogs or ever play in a group setting? (required) Yes NoDoes your dog recall well? (required) Yes NoDoes your dog ever bark excessively? (required) Yes NoWhy do you want to bring your dog to play time? (required)