K9 Nanny Service DAYCARE APPLICATION-CONTACT INFORMATION Owner Information: Name: __________________________________ Address: _____________________________________________________ Email: ________________________ Home phone: ___________________ Work Phone: ___________________ Emergency Contact: Name: __________________________________ Address: _____________________________________________________ Email: _________________________ Home phone: __________________ Work Phone: ____________________ Pet Information: Name: ____________________ Breed: _________________ Sex: _______________Weight: ___________________   D.O.B._____________ Veterinarian: Name: ______________________________________________________ Address:____________________________________________________ Phone: ________________________ Fax: _________________________ Pet Personality Profile: Owner's Last Name: _________________________________ How did you hear about K9 Nanny Service?____________________________ Dog's Name: ____________________________ Date you acquired dog: _____________________ Is dog spayed/neutered? ______    At what age was it done_________________ Where did you get your dog? ________________________________________ If adopted, do you have any knowledge of your dog's past history? __________________________________________________________________ _________________________________________________________________ Does your dog like children?   Y   N   DK How does your dog behave around children? _____________________________ Are there other animals in your household? If so, please list type, sex and age of each: __________________________________________________________________ How does your dog get along with other resident animals? __________________________________________________________________ __________________________________________________________________ Health/Grooming: Does your dog have a problem with fleas? _____ Allergies? _________________ Does your dog have hip dysplasia? ___________ If yes, what restrictions need to be placed on your dog's activities or movements? __________________________________________________________________ Does your dog like to be brushed? ____________________________________ How does your dog react to having his/her nails clipped? __________________________________________________________________ Does your dog have any sensitive areas on his/her body? _________________________________________________________________ Behavior: Does your dog act afraid of any specific items or noises? If so, please explain: __________________________________________________________________ How does your dog react to strangers coming into your home or yard? __________________________________________________________________ Does your dog ever bark or growl at anyone passing outside you home or yard? __________________________________________________________________ Are there any kinds of people your dog automatically fears or dislikes? __________________________________________________________________ Are there any kinds of dogs your dog automatically fears or dislikes? __________________________________________________________________ How does your dog react to puppies? __________________________________________________________________ Has your dog ever: Growled at someone? ___________ What were the circumstances? _________________________________________ __________________________________________________________________ Bitten someone? ____________ What were the circumstances? _________________________________________ __________________________________________________________________ Does your dog have any problems in any of the following areas: Mouthiness: __________Housetraining:____________Barking:______________ Digging: _______Jumping: _________Other:_____________________________ Has your dog ever growled or snapped at anyone who has taken his/her food or toys away from him/her? ______________ What were the circumstances? __________________________________________________________________ Has your dog ever shared his/her food or toys with other animals? _____________ Does your dog play with any toys? _____________ If yes, what kinds of toys does your dog like and what games does he/she play? ________________________________________________________________ Has your dog ever had any formal obedience training? _______If yes, when and where?____________________________________________________________ What commands does your dog know? __________________________________________________________________ __________________________________________________________________ Other comments about your dog which you feel might be helpful: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Initials:___________________________   Date:___________________________