Daycare Interview Form

Name*
First Last
Date*
MM slash DD slash YYYY
Phone*
please enter in this format (###) ###-####
Email*
How did you hear about us?*
Dogs Name:*
Dogs Breed:*
Dogs Age:*
Date of Adoption or Birthday*
MM slash DD slash YYYY
Is your pooch*
- spayed
- neutered
- intact
Most recent vet visit and results:*
Any current medical issues:*
- No
- Yes
If Yes, please describe.*
Current on vaccinations? Rabies Bordatella Other:*
Where have you taken your dog to training classes?*
How comfortable is your pup walking on leash in the city?*
Do you take your dog to any local dogs parks or off leash dog areas? If so- how comfortable is your pup in these types of environments?*
Has your pooch ever gone to daycare before?*
- No
- Yes
How did he respond*
How did you feel about the experience*
What led you to look for a new daycare?*
How do you expect your pooch will respond to daycare? Enjoy the opportunity to play with other dogs? Be nervous? Settle in quickly? Not sure*
Do you have any concerns for your pooch about attending daycare?*
Does your pooch have any toys he prefers not to share with other dogs?*
- No
- Yes
Which toys?*
How does your pooch respond when another dog approaches where she's resting?*
What about when another dog approaches you?*
Does that change if you have food or treats?*
How does your pooch let other dogs know he doesn't want to share?*
Does your pooch have any toys he prefers not to share with humans?*
- No
- Yes
If yes, which toys?*
What does your pooch do when a peson reaches for something she has?*
How does your pooch respond when a person approaches where she's resting?*
What if another person approaches you?*
Does that change if you have food or treats?*
- No
- Yes
How does your pooch let people know he doesn't want to share?*
How many dog friends does your pooch have?*
- None
- One
- Two
- Many
- A few
How often does your pooch have a chance to meet new dogs?*
- Weekly
- Occasionally
- Rarely
Please describe what kind of socialization & exposure to city life your pup currently has.*
Would you say that your pooch warms up to new dogs:*
- Quickly
- Slowly upon first meeting
- Over many meetings
- Never
Would you say that your pooch is most comfortable:*
- Touching and interacting with other dogs
- Being near but not too near
- Interacting at a distance
- Not at all
What does your pooch do when he meets a new dog for the first time?*
Is your dog crate trained or comfortable in a crate? Please explain how you use or don't use a crate for your pup.*
Has you pooch ever had a spat with another dog?*
- No
- Yes
Did the incidents involve:*
- Males
- Females
Specific breed*
Specific size of dog*
- Puppies
- Adolescents or young dogs
- Older dogs
Particular playing style (chasing, etc.)*
Too close a distance*
- Yes
- No
Too long a duration of greeting*
- Yes
- No
Dogs approaching directly having rear end sniffed*
- Yes
- No
Other
- Yes
Tell me what happened*
What kind of dog does your pooch prefer to play with?*
- Big dogs
- Small dogs
- Mid-size dogs
- Older dogs
- Rowdy/energetic dogs
- Laid back dogs
- Puppies
- Other
How often does your dog use any of the following play behaviors or signals with other dogs?
Play bow*
- Often
- Sometimes
- Never
Raised play paw*
- Often
- Sometimes
- Never
Fast tail wag*
- Often
- Sometimes
- Never
Ears back*
- Often
- Sometimes
- Never
Open, smiling mouth*
- Often
- Sometimes
- Never
Investigative greeting*
- Often
- Sometimes
- Never
Bouncy, exaggerated movement*
- Often
- Sometimes
- Never
Chasing with pauses and role reversals*
- Often
- Sometimes
- Never
Wrestling with pauses and role reversals*
- Often
- Sometimes
- Never
Barrier Frustration
What does your pooch do when she sees another dog while she's on leash?*
What does your pooch do when she sees another dog when she's behind a fence or looking out through a window such as at home or in a car?*
Dog- People Relations
Would you say that your pooch warms up to new people*
- Immediatly
- Quickly
- Over time
Is your pooch comfortable
Having her collar/ harness put on and taken off*
- Loves it
- Tolerates it
- Hates it
How can you tell?*
Having her leash put on and taken off*
- Loves it
- Tolerates it
- Hates it
How can you tell?*
Being picked up, petted,and hugged*
- Loves it
- Tolerates it
- Hates it
Has your pooch ever bitten or snapped at a person?*
- No
- Yes
Did the incident involve*
- Male
- Female
- Child aged
- Toys or other objects
- Food
- Space (such as a favorite couch, bed, sleeping spot
- Being approached
- Being reached for or picked up
- Being petted on
- Other/not sure
Tell me what happened*
Bite levels
Any incidents of a bite or bites to other dogs?*
- No
- Yes
What is the worst result that has occurred?*
- Bared teeth,snarl,growl
- 1) Snap
- 2) Contact with zero damage
- 3) 1 to 4 shallow punctures
- 4) 1 to 4 deep punctures and/or bruising
- 5) Deep bi-directional tears
- 6) Multiple level 4s and 5s
- Fatality or mutilation
Any incidents of a bite or bites to a human or humans?*
- No
- Yes
What is the worst that has occurred?*
- Bared teeth,snarl,growl
- 1) Snap
- 2) Contact with zero damage
- 3) 1 to 4 shallow punctures
- 4) 1 to 4 deep puncturesand/or bruising
- 5) Deep bi-directional tears
- 6) Multiple level 4s and5s
- Fataliy or mutilation
* Bite levels as defined by Dr. Ian Dunbar
You acknowledge use of your email for Bark Avenue use only*
- Yes
We will use your email on file for general check in's, and monthly email updates regarding billing, closures, and any events. Please make sure to check your email to make sure you are receiving these as it contains useful info & important updates. We do not "sell" your information. Only for Bark Ave staff to communicate with you.
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