Barks & Recreation | Eau Claire, WI

715.579.8285

Daycare Evaluation Form
Please submit one application for each dog who you would like to have attend daycare
Name *
Phone Number *
Dog's Name
Breed (or best guess)
Age
How long have you owned your dog?
Has your dog attended day care before
If yes, how long ago?
Where did you get your dog?
Why are you considering daycare? check all that apply
Which best represents your dog’s interactions with other dogs
Please describe your dog’s flea/tick control and prevention program, natural or medical?
Does your dog have any allergies? If yes, please explain.
Does your dog have any physical disabilities? If yes, please list any restrictions on your dog’s activities or movements
Does your dog have any medical conditions? Yes- If yes, please explain. If medication is used, please provide name and dosage
Does your dog like to be bathed/brushed?
Does your dog have any sensitive areas on his/her body?
Check the box below that best describes your dog’s regular exercise level
Please list any other pets in your home
Does your dog get along with other pets?
Does your dog like kids?
Do you ever have visitors that bring their dogs with? If yes, how does your dog react?
How does your dog react to a stranger in your home/yard?
How does your dog react to puppies?
Are there any types/breeds of dog that your dog seems to automatically fear or dislike?
Does your dog play with other dogs
Has your dog ever shared food/toys with other animals?
Has your dog had any obedience training? If yes, please describe
Has your dog ever had issues in an off-leash social envioronment? If yes, please explain
Does your dog have any issues in the following areas? Please check all that apply
Are there any particular types of people that your dog seems to automatically fear/dislike?
Has your dog ever growled at someone? If yes, please explain.
Has your dog ever bitten a person? If yes, please explain
Has your dog ever bitten another animal? If yes, please explain
Has your dog ever climbed/jumped a fence? If yes, what were the circumstances and how high was the fence?
Has your dog ever escaped from your house/yard? If yes, what were the circumstances?
Has your dog ever chased or tried to chase another animal? If yes, what were the circumstances?
Has your dog ever chased someone on a moving object? Ex: in a car, on a bike/skateboard If yes, what were the circumstances?
Is your dog frightened of thunderstorms?
Has your dog ever growled/snapped at a person trying to take food/toys away? If yes, what were the circumstances?
Has your dog ever growled/snapped at another animal who has taken food or toys away? If yes, what were the circumstances?
Please list any information you feel might help us determine if your dog is a good fit for daycare
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