Rompin' Rovers Playgroup Application
Application for Canine Aspirations' Rompin' Rovers Playgroups
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Email *
Owner's Name *
Street Address *
Phone number *
Emergency Contact *
Emergency Contact Phone Number *
Emergency Contact Email Address *
Dog Name *
Sex of Dog *
Breed or Breeds of Dog (if known) *
Dog Age or Birthdate *
Dog Weight *
Tattoo or Microchip #
Veterinarian Name *
Veterinarian Phone *
Date of Last Vet Exam
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History of Illness?
Where did you get your dog? Please be as specific as possible. *
If adopted, do you have any knowledge of your dog's past history?
How does your dog get along with other animals in the household?
How is your dog typically exercised each day?
Is your dog used to being crated? If so, what size crate? Plastic or wire? *
Does your dog act afraid of any specific items or noises? If so, please explain in detail: *
Are there any kinds of people your dog automatically fears or dislikes? If so, please explain in detail: *
How does your dog react to puppies? *
How does your dog react to dogs larger than him/her? *
How does your dog react to dogs smaller than him/her? *
Has your dog ever growled at anyone? If yes, please explain the circumstances in detail. *
Has your dog ever bitten anyone? If yes, please explain the circumstances in detail. *
Does your dog have any problems in any of the following areas:
Has your dog ever escaped from a fenced in yard? If yes, please describe the circumstances. *
Has your dog ever growled or snapped at anyone who has taken his/her food away? If so what were the circumstances? *
Has your dog ever growled or snapped at anyone who has taken his/her toys away? If so what were the circumstances? *
Has your dog ever shared toys with other animals? *
Does your dog like to play with toys? If yes, what kind/s of toy/s and what games does he/she like to play? *
Does your dog like to play with other dogs? IF yes, what age/size/sex dog/s does he or she typically like to play with? *
Has your dog had any obedience training? If yes, when and where? *
What cues does your dog know? (Sit, down, stay, come, tricks, etc...) *
Any other comments about your dog which you feel might be helpful?
I hereby certify that my dog is in good health and has/have not been will with any communicable condition in the last 10 days. I further certify that my dog has/have not harmed or shown aggressive behavior towards another human or any other dog. *
I understand that I am solely responsible for any harm caused by my dog while my dog is attending Canine Aspirations. *
I further understand and agree that in admitting my dog to Canine Aspirations, the staff have relied upon my representation that my dog is in good health and has not harmed or shown aggressive behavior towards another person or dog. *
I further understand and agree that Canine Aspirations and their staff and volunteers, will not be liable for any problems that develop, provided reasonable care and precautions are followed. *
I hereby release Canine Aspirations and their staff and volunteers of any liability of any kind whatsoever arising from my dog's attendance and participation at Canine Aspirations. *
I further understand and agree that dogs can sometimes receive minor cuts and scratches during playgroups or boarding and any problems that develop with my dog will be treated as deemed best by staff and volunteers of Canine Aspirations. *
I will assume full financial responsibility for any and all expenses involved in treating my dog while under care at Canine Aspirations. *
I certify that I have read and understand the policies of Canine Aspirations as set forth on the preceding pages and that I have read and understand the conditions and statements of this agreement. *
A copy of your responses will be emailed to the address you provided.
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