Admission Questionnaire for The Big Backyard
5310 E. Pacific Place
Denver, CO 80222
(303) 757-7905

SHOT RECORD
Bord:___________
Rabies:____________
Distem:_____________

Date:________________

Owner Information: (please print)
Name:__________________________________________
Address:________________________________________
City:_______________________    Zip:___________
Home Phone:_______________    Work Phone:_________________
Cell Phone:_______________    Cell Phone:_________________
Employer:________________________________________

How did you hear about The Big Backyard?
(please check one)
A Referral (if so provide name, we'd love to reward our customer w/ a free day) ______________________________
Yellow Page Ad ______ Web Search _____ Vet ____________________
Other ________________

Emergency contact: (should not be the same as above)
Name:____________________________   Relationship:____________________
Phone:_______________________ Cell:_______________________

Pet Information:
Name:_______________________    Breed:__________________ Color:________________    Sex:_____________
Birthdate:______________________    Weight:_____________
Is your dog spayed or neutered? ___________________
We do require your dog over the age of 6 months to be spayed or neutered if attending daycare or boarding.

Veterinarian:
Name of Animal Hospital:___________________________________
Phone:________________________________


The following people may pick up my dog from The Big Backyard:
____________________________________________________
____________________________________________________

Owner Profile:

1. How old was your dog when you got him/her? _________
2. Where did you get him/her? (breeder, pet store, etc.)_____________________________
3. If you got your dog after she/he was 3 months old, what information do you
   have about your dog's past history?
   ______________________________________________
   ______________________________________________
   
   
4. How long is your dog left alone during the weekdays?_________________________
5. Where does she/he stay during that time? (crate, kitchen, yard, etc.)
   _____________________________________________
6. Is your dog crate trained?______________________
7. Is your dog house trained?______________________

Dog Personality Profile:

1. Does your dog have any behavioral issues or destructive habits when left alone (if so, please explain)?
   _________________________________________________________________
   _________________________________________________________________
   
   
2. Does your dog bark a lot (if so, what provokes it)?
   _________________________________________________________________
   _________________________________________________________________
   
   
3. Does your dog get frightened by unfamiliar noises (if so, please explain)?
   _________________________________________________________________
   _________________________________________________________________
   
   
4. Does your dog have a fear of thunderstorms (if so, what happens)?
   _________________________________________________________________
   _________________________________________________________________
   
   
5. Has your dog ever jumped or climbed over a fence? If so, how high?
   _________________________________________________________________
   _________________________________________________________________
   
   
6. Has your dog ever bitten another person or dog? ______ If yes, please describe:
   _________________________________________________________________
   _________________________________________________________________
   
   
7. Can you take a food based item away from your dog w/o him growling? ___________________
   
   
8. Has your dog ever socialized with a large group of dogs (more than six)?
   ______
   If yes, please describe:
   _________________________________________________________________
   _________________________________________________________________
   
   
   
   
9. Is there any type of person (children, men, etc.) your dog routinely dislikes or fears? If yes, please describe:
   _________________________________________________________________
   _________________________________________________________________
   
   
10. Is there any type of dog (specific breed, male, female, etc.) your dog seems to have a problem with? If yes, please describe:
    _________________________________________________________________
    _________________________________________________________________
    
    
11. Does your dog show a particular fondness or interest toward a specific breed of dog? If yes, please describe
    _________________________________________________________________
    _________________________________________________________________
    
    

(If you need more space to elaborate on certain questions, please feel free to use the back of the page)

Dog Health Profile:

1. Does your dog have any "old" injuries that we need to be concerned about while at daycare? ________________________________________
   
   
2. Are there any restrictions that should be placed on your dog's activities?
   _________________________________________________
   
   
3. Does your dog take any medication for chronic illness (if so, for what ailment)?
   ________________________________________
   
   
4. Does your dog have allergies (if so, to what)?
   _________________________________________________
   
   
5. What brand of food does your dog eat?
   _________________________________________________
   
   
6. Are there any areas on your dog's body that does not like to be touched by humans (ears,paws,etc.)?
   _________________________________________________
   
   

Dog Etiquette:

1. How does your dog react to strangers coming into (or near) your home/yard? _________________________________________________________________
   _________________________________________________________________
   
   
2. Do visitors bring dogs to your home? ______ How does your dog react? _________________________________________________________________
   _________________________________________________________________
   
   
3. Is it common for your dog to jump on you or other people (if so, how do you respond to this)? _________________________________________________________________
   _________________________________________________________________
   
   
4. Will your dog readily share toys with other dogs? _________________________________________________________________
   
   
5. Does your dog wrestle with other dog's __________ If yes, does your dog usually take the top or bottom position when wrestling? _________________________________________________________________
   _________________________________________________________________
   
   
6. When your dog meets another dog (off-leash), describe your dog's greeting? _________________________________________________________________
   _________________________________________________________________
   
   
7. Has your dog ever played with dogs less than 15 lbs.? _________________________________________________________________
   
   

Thanks for choosing The Big Backyard, Dog's Daycare Dream!