Pet Information Disclosure

Pet Owner Name *

First Name

Last Name

Last Rabies Vaccination: *

MM

DD

YYYY

Last Distemper Vaccination: *

MM

DD

YYYY

Heartworm Prevention Due On: *

MM

DD

YYYY

Flea/Tick Prevention Due On: *

MM

DD

YYYY

Is your pet on any medications?

Yes

No

Is your pet allowed treats?

Yes

No

Does your pet have allergies?

Yes

No

Classify your dog’s personality:

Shy

Hyper

Mellow

Driven

Anxious

Goofy

Please check the things your pet does NOT like:

Baths

Nails Clipped

Massage

Ears touched/ cleaned

Cats

Rain

Snow

Cold

New/Other Animals

People or pets near food dish

Loud noises

Strangers

Sharing Toys

Please check any of the following that are TRUE:

My pet has...

attacked or bit someone

attacked or bit another animal

escaped from an enclosed area

injured self out of boredom

May we bring your dog on an adventure in the car outside of our camp facility?

Yes

No

Does your pet have good recall?

Yes

No

Is your pet allowed off leash?

Yes

No

Is your pet allowed on furniture?

Yes

No

Does your dog like interacting with people or dogs more?

People

Dogs

Does your dog stick around when other dogs are present?

Never

Sometimes

Often

Always

Not Sure

Does your dog come back within a minute when called?

Never

Sometimes

Often

Always

Not Sure

Is your dog friendly toward other dogs off-leash?

Never

Sometimes

Often

Always

Not Sure

Does your dog ever run away?

Never

Sometimes

Often

Always

Not Sure

Do other people take your dog off-leash and hike them?

Never

Sometimes

Often

Always

Not Sure

What happens when you toss a treat on the ground near your dog and another dog comes up? Have they ever resource guarded food or a high value object like a bone?

Never

Sometimes

Often

Always

Not Sure

Does your dog do well in the car?

Never

Sometimes

Often

Always

Not Sure

Does your dog do well in a car with other dogs?

Never

Sometimes

Often

Always

Not Sure

Does your dog bark in the car?

Never

Sometimes

Often

Always

Not Sure

Does your dog bark at men?

Never

Sometimes

Often

Always

Not Sure

Is your dog friendly toward other dogs on leash?

Never

Sometimes

Often

Always

Not Sure

Has your dog every resource guarded another person? Do they ever get jealous of other dogs or people saying hi to you?

Never

Sometimes

Often

Always

Not Sure

Does your dog bark at women?

Never

Sometimes

Often

Always

Not Sure

Does your dog bark at kids?

Never

Sometimes

Often

Always

Not Sure

Does your dog roll in stinky stuff?

Never

Sometimes

Often

Always

Not Sure

Does your dog chase any animals?

Never

Sometimes

Often

Always

Not Sure

Is your dog treat driven?

Never

Sometimes

Often

Always

Not Sure

Does your dog like to swim?

Never

Sometimes

Often

Always

Not Sure

Does your dog like to play ball?

Never

Sometimes

Often

Always

Not Sure

Has your dog every played too rough with another dog and the other dog looked uncomfortable or vocalized?

Never

Sometimes

Often

Always

Not Sure

Does your dog over heat in the summer?

Never

Sometimes

Often

Always

Not Sure

Is your dog able to keep up with you on a long hike/walk?

Never

Sometimes

Often

Always

Not Sure

Does your dog have frequent accidents in the house?

Never

Sometimes

Often

Always

Not Sure

Do you frequent the dog park?

Never

Sometimes

Often

Always

Not Sure

We will need a copy of your vet records, including a copy of a negative fecal test result within the last 6 months. Will you:

Bring your vet records with you on the day of your visit

Email your vet records to us prior to the visit (vtbarksandrecreation@gmail.com)

Can we put pictures of your dog up on our social media?

Yes

No